EV Screening & Compliance — Employer Account Application

EV Screening Employer Account Application

Enter your organization and contact details, then certify authorization and sign to submit for account review.
Legal Business Name
Doing Business As (DBA)
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Industry
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Website
Estimated Monthly Tests
Primary Contact Name

First NameLast Name
Primary Contact Title
Primary Contact Email
example@example.com
Primary Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
EMPLOYER ACCOUNT APPLICATION TERMS
This form is only an application for an EV Screening employer account. Submitting an application asks EV Screening to review the employer's information. Submission does not approve the employer, permit test ordering, or make the employer eligible to order. EV Screening reviews applications manually. If EV Screening approves the application, EV Screening will send a separate Employer Service Agreement through DocuSign. The employer becomes eligible for production ordering only after the employer signs that separate agreement, EV Screening records the completed agreement, and production ordering is released. The person submitting the application confirms they are authorized to submit it for the organization and that the information provided is accurate.

APPLICATION PRIVACY NOTICE
EV Screening collects the organization's name, business address, industry, business phone, website, estimated monthly test volume, and the business contact information entered in this application. EV Screening uses this information to review the application, contact the submitted business contacts about the application, maintain the application and employer account record, and, if the application is approved, prepare and send the separate Employer Service Agreement through DocuSign. Please provide accurate business and contact information and do not include information that is not requested. For application contact updates or questions about this notice, contact info@evscreening.com.
I certify that I am authorized to request this account for the organization and that the information I provided is accurate.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Submission does not automatically approve an account or authorize testing.
Job Fair / Partner Referral Code
Participating in a partner hiring event? Enter the Partner ID provided by your event organizer to request exclusive employer pricing.
Should be Empty:

EV Screening Employer Account Application