Sample Report

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The following example is based on an actual report LaCosta Data Services filed with

one of our clients.  Reports can be either faxed or e-mailed.

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LACOSTA DATA SERVICES—972 250 0592—FAX NUMBER OF PAGES—2             01/19/99

REPORT ON APPLICANT

VIA FACSIMILE  TO:    JOHN SMITH--MANAGER ABC CONVENIENCE STORES

ANYTOWN, TX           (999) 555-1212

APPLICANT’S NAME:   John Harold Doe         SOCIAL SECURITY: 000-00-0000  

TX DRIVER’S LICENSE  00000000                   AVAILABLE: FULL TIME/DAY/EVENING/NIGHT

  1. RECENT EMPLOYMENT (LAST FOUR JOBS)

C&P Convenience Store—5/98 through 1/99—fired for being rude to customers and several shortages in the register—usually $25 at a time, B. Grandma's Chicken Shack—9/97 through 5/98—left for a job with better pay--no notice given, C. Shorty's Bar and Grill—2/97 through 9/97—fired for pocketing cash payments, D. Center City Spa—7/94 through 2/95—fired due to personality conflict with manager.

  1. PERSONAL OBLIGATIONS: Applicant not sure but may have some "insufficient fund" checks out--has not checked to find out--said he never opens any letters from bank--quits writing checks when he thinks money is about gone.  Owes money to DEF Fiancée--about $4,000--quit making payments about one year ago.
  2. DRIVING RECORD: License suspended in 95 but was reinstated in 6/98. Loss of license stemmed from wrecking auto and not carrying auto insurance.
  3. CRIMINAL RECORD: Agreed to plead guilty for an Indecent Exposure arrest on 11/11/92—60 days and six months probation, Found guilty on a Public Lewdness charge stemming from an arrest on 2/2/92—served 120 days and given a 12 month probation. Arrested in Center County in 1994 for theft by check—given a one year probation—re arrested 10/96. Applicant stated that he has violated the terms of his probation and is currently facing possible jail time.
  4. ALCOHOL/DRUGS: Consumed alcohol on the job while working as a bar back, also used and sold illegal drugs while working as a bar back. Used cocaine regularly until eight months ago and has been clean for two months. Currently attends Narcotics Anonymous.
  5. HEALTH: Good
  6. JOBSITE INJURIES: Pulled knee while working on job in 1988—off work six weeks.
  7. THEFT AND/OR CONSUMPTION OF COMPANY GOODS: Has taken small food items at different jobs. Also applicant was fired from a job in Center City (Quickstop Store) for inventory shortage in 1990.
  8. SPECIAL NOTES: A search of the Center County Civil cases showed that applicant was filed upon on three separate occasions in 1995 for eviction from an apartment.

ANY QUESTIONS PLEASE CONTACT DIANNE ROBINSON AT 972 849 5901.

 

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Last modified: Monday May 22, 2000.