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Request Entered--Reference Number #_________________ UCSD CONSUMER REPORT REQUEST FORM FOR BACKGROUND INVESTIGATION
 

Summary: Request Entered--Reference Number #_________________
UCSD CONSUMER REPORT REQUEST FORM FOR BACKGROUND INVESTIGATION
SERVICES REQUESTED
Check ONLY the boxes of the services you are requesting and fill out required information.
SOCIAL SECURITY NUMBER TRACE: SSN: __________________ Country of Origin: US UK Canada Other
FEDERAL CRIMINAL RECORD: FEDERAL DISTRICTS WILL BE ORDERED FOR RESPECTIVE COUNTIES LISTED BELOW
COUNTY CRIMINAL RECORD: List all former Counties [or Cities] and States of residence for the last seven [7] years:
1. _____________________________ 3. _____________________________ 5. _____________________________
2. _____________________________ 4. _____________________________ 6. _____________________________
NATIONAL SEX OFFENDER SEARCH:
STATEWIDE SEX OFFENDER SEARCH:
WORLD CHECK: (World-Check is a database of highly structured profiles on heightened risk individuals and entities such as
terrorists, fraudsters, narcotics traffickers, shell banks, PEPs (Politically Exposed Persons), organized crime, sanctioned entities, plus
many other categories including those that may pose a lesser risk but are equally of interest.)
EDUCATION VERIFICATION: Complete all fields below. Name and degree info should match the info located in the school records.
First Name: _________________________________________________________
Middle Name: _________________________________________________________
Last Name: _________________________________________________________
Institution Name and Campus Location: _________________________________________________________________
Institution Address: _________________________________________________________________________________

  

Source: Abagyan, Ruben - School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego
Gleeson, Joseph G. - Department of Neurosciences, University of California at San Diego

 

Collections: Biology and Medicine