Maryland Washington, DC Baltimore/Annapolis Nationwide (toll free) 301-656-LOCATE 202-575-LOCATE 410-269-LOCATE 888-506-LOCATE (FAX) 301-670-LOCATE

Corporate Address  11140 Rockville Pike #165 Rockville, Maryland 20850

Information needed to initiate search reports (To be filled out by employer - please print clearly). It is the employer's responsibility to collect and make sure all information recorded on the Employer's order form is accurate, correct and complete according to any of applicants identifications or verbal responses. Any error in name spelling, order or number-sequences could jeopardize Investigative Search Reports on applicants. Unfortunately, because Search And Locate Investigations does not have access directly with the applicant or their information, Search And Locate Investigations can not be responsible for any information recorded on this form. If you have any questions or concerns, please contact us.

Name of Applicant First Middle Last
Any other names known by in the past 7 years.	___________________________________________
Has Applicant's name ever been legally changed?	Yes_______ No_________
If yes, Legal Name:	___________________________________________
Present Address:	___________________________________________
Street City County State Zip Code How Long	___________________________________________
Applicant's Previous Address: (Please list all of Applicant's addresses within the last 10 years)	___________________________________________
Street City County State Zip Code How Long	___________________________________________
Date of Birth	___________________________________________
Social Security Number:	___________________________________________
Driver's License Number:	___________________________________________
State	___________________________________________
Has Applicant ever been convicted of a crime?	Yes No Misdemeanor Felony CaseNumber________________
If yes, please explain reason for Conviction and outcome of Conviction( time served dates and probation dates)	___________________________________________
Pre-Employment screening release: I, the above applicant agree to have investigative background inquiries made about myself regarding criminal records, motor vehicle records, credit records, employment history and any other subjects or sources as deemed necessary by Search And Locate Investigations. I understand that information will be requested from various federal, state and other agencies which maintain records concerning any and all of my past experiences. I authorize Search And Locate Investigationsand any agencies, companies, corporations, law enforcement, educational institutions and persons from nationwide to obtain and supply background information about myself. I hereby release and hold harmless Search And Locate Investigations and their sources from any effects a background search may have on my ability to obtain work or any other effects a background search may have on me. I understand that Search And Locate Investigations is strictly providing information about myself for my future employees and has not in any way guaranteed or promised me a position. This authorization shall be valid for one year from the date signed below.  A copy of this statement shall have the same effect as an original. The agreement shall be construed in accordance with the laws of the state of Maryland. Search And Locate Investigations will be known as, and is also part of Search and Locate Investigations, Inc.
Applicant's Signature (optional):	Date:
Search And Locate Investigations will not disclose any of your information either on this document, or any other information we retrieve to anyone, except the potential employer who has authorized Employer's Order Form. I hereby order Search And Locate Investigations to perform the searches I have selected on the bottom of this page. I understand that it will take Search And Locate Investigations approximately 7 business days from the date Search And Locate Investigations receives the Employer's Order Form, fully completed on both sides and my method of payment, all signed and dated to be able to return the results that I have ordered.
Employer's signature:	Date:
Employers Name and Address
(Some state jurisdictions may take longer to receive a criminal or driving record report.)
You may purchase our reports separately or any of the combination plans to fit your needs.
**Criminal Search by Jurisdiction	$59.00
**Criminal Search State  (State of New York Only)	$129.00
**Criminal Searches are searched by NAME KNOWN BY ONLY**(CORRECT SPELLING REQUIRED, EACH NAME IS A SEPARATE FEE) It is recommended to collect applicant's name by viewing an official piece of identification and/or ordering our Social Security Number Verification Report to obtain all names applicant is known by.
Statewide Driving record  (State of Maryland Only)	$49.00
Validation of History of Vehicle Operation OUT OF STATE DRIVING RECORD	$109.00
Social Security Number Verification	$59.00
Civil Records Search	$69.00
Extensive Background Search	$89.00
(When ordering plan). COMBINATION PLANS	$69.00
Plan #1 Maryland Driving Record, Criminal Search (one jurisdiction) and Social Security Number Verification	$149.00
Plan #2 Criminal Search (one jurisdiction) Civil Records Search (one jurisdiction or county)  and Social Security Number Verification	$179.00
Plan #3 Criminal Search (one jurisdiction) Maryland Driving Record, Social Security Number Verification, and Civil Records Search (one jurisdiction or county)	$209.00
Plan #4 Criminal Search (one jurisdiction) Civil Records Search (one jurisdiction or county), Maryland Driving Record, Social Security Number Verification, and Extensive History Report	$289.00
**Add extra to plan for out of state driving record other than Maryland**	$69.00
Please specify jurisdictions (Counties and/or Cities and States) of Criminal and Driving Record. Search Reports Ordered (required):
TERMS AND CONDITIONS: (This section must be completed in full by Employer to authorize your search.) Employer's Disclosure and Release. I, the employer, understand that Search And Locate Investigations will supply me with only the information and documentation I am requesting on the above listed applicant.  I have allowed several different companies, government agencies, and other sources to obtain information on the individual listed above. I understand that at times information supplied to Search And Locate Investigations from different private sources, computer systems, public information facilities, government open records institutions, documents received from across the states and other countries, and any other countries, and any other sources may have items which are incomplete, incorrect, omitted, misspelled, or deleted and that this is out of the control of Search And Locate Investigations and Search And Locate Investigations resources. Search And Locate Investigations searches are obtained from public record sources. I hereby indemnify and release Search And Locate Investigations, and their resources of any liability and hold them harmless for any and all information and documentation provided by me. I do understand that for the fee enclosed Search And Locate Investigations will supply me with the information (complete or incomplete) requested on the above individual based on the information given on the employee order form. Any false, misleading, or withheld information given or not given by the above individual on the employee order form is out of the control of Search And Locate Investigations and their resources and I will not hold them liable for the background search and results based on the information supplied by the applicant. I also understand that I am providing Search And Locate Investigations with a limited fee amount that is specified on the employer's order form. Search And Locate Investigations will strictly perform with the limited fee amount offered. Any other above or more extensive investigations I choose to entail I will contact Search And Locate Investigations and give my authorization to increase the cost to perform other searches. Search And Locate Investigations will conduct research in accordance to the identity of the subject, information and fee provided. Search And Locate Investigations is not participating in my decision of hiring any potential employee and I will not hold Search And Locate Investigations liable for any hiring decisions I may make. Any decisions I make or actions I take after receiving the background information I have requested on this order form will be strictly my own. Furthermore, I shall not disclose the results of the background searches obtained from Search And Locate Investigations to anyone. I will not share the results of any background searches with my prospective employee (s) and I will refer any questions to Search And Locate Investigations. The agreement shall be construed in accordance with the laws of Maryland. No express or implied warranty is made including, but not limited to, fitness or youth for and purposes or merchant ability. This authorization shall be valid for one year from the date signed below. A copy of this authorization shall have the same effect as an original. Search And Locate Investigations will be known as, and also is part of Search and Locate Investigations, Inc.  I hereby certify that I have read, understand and agree will all Search And Locate Investigations terms and conditions.
Employers' Signature And Date:
Employer's Full Name	:
Full Address	:
Home Phone Number	:
Work Phone Number	:
Fax Phone Number	:
Method of Payment: MARYLAND RESIDENTS MUST ADD 5% SALES TAX TO TOTAL	:
AMOUNT OF FEES.	:
I (we) authorize selected credit card billing for : Master Card Visa American Express Discover Card Account Number	:
Expiration Date	:
Name of the Bank that issued the Credit Card	:
ID code ( on the back of the card, by the signature line)	:
Credit Card Customer Service Number	:
Sub Total	:
5% Tax (Md Residents only)	:
Total Fee Amount $	:
Signature of Purchaser/Card Holder	:
Print Name as it appears on card	:

After completing all information above,  fax the order form to 301-670-5622.