Information submitted on this form is sent using a secure encrypted connection and is automatically wiped from our system after a limited amount of time to protect your privacy.
Last Name *
First Name *
Current Address *
Date of Birth
Driver's License Number
If Multi-state, list states:
$10 additional charge for expedited service-1hr guarantee, $10 for each additional state.
Credit Card Number *
Credit Card Type *
Select Credit Card Type
Card Expiration Date *
Security Code *
Name on Card *
Billing Address *
I agree to the terms and conditions listed below.
Terms and Conditions
The information contained in this application is correct to the best of my knowledge.
I hereby authorize Rock Security and its designated agents and
representatives to conduct a comprehensive review of my background causing a consumer report
and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I
understand that the scope of the consumer report/ investigative consumer report may include, but is not
limited to the following areas: verification of social security number; credit reports, current and previous
residences; employment history, education background, character references; drug testing, civil and
criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions;
driving records, birth records, and any other public records.
I further authorize any individual, company, firm, corporation, or public agency to divulge any and all
information, verbal or written, pertaining to me, to Rock Security or its
agents. I further authorize the complete release of any records or data pertaining to me which the
individual, company, firm, corporation, or public agency may have, to include information or data
received from other sources. Rock Security and its designated agents
and representatives shall maintain all information received from this authorization in a confidential
manner in order to protect the applicants personal information, including, but not limited to, addresses,
social security numbers, and dates of birth.