SecurHomeland® An exclusive system for ACCURATIZED® Background Reports


iReviewNow Online Option

All information must be completed. .

Your employer or prospective employer has conducted a criminal history search, which has revealed information that may be your record. It is mandatory and important for you to fill out this form with the criminal record report in front of you.

As the prospective employer or existing employers do not automatically exclude an applicant or employee with a criminal record, the following questions must be answered for your application to be considered or for you to be eligible for continued employment.

The Fair Credit Reporting Act requires that you verify the accuracy of this report to protect your rights.

Important information follows and requires your immediate response for you to be considered an active applicant for employment and that your record as provided to you is accurate. There are several benefits for your immediate response, which include: (1) You let the prospective employer know you are a serious candidate wanting to go to work. (2) You are able to provide positive information to the prospective employer that should be considered when reviewing your background records. (3) You are able to identify inaccurate and accurate records that will insure only the right information is being considered by the prospective employer.

As you authorized a pre-employment background checks was made as part of your application for employment. This is to inform you that information in the report, if accurate, may prevent your being offered employment by the prospective employer. A copy of this report and A Summary of Your Rights were previously sent to you.

To help expedite or speed up the hiring process you have five days to answer a few questions to help us evaluate your background information. We want you to provide this information, as we do not automatically discriminate against applicants with a past record. We take in consideration your explanations, the dates, records, and other information to make sure we have a consistent and fair employment process in our hiring decisions.

Though SecurTest, Inc., or its affiliates, provided this report, they do not make the hiring decision. It is your obligation to make sure this information is accurate, includes your explanations, and positive information as to why we should consider you for employment.

A description of your rights under the federal Fair Credit Reporting Act was previously provided to you with a copy of the report. Under the law, you may dispute, directly with SecurTest, Inc., any information in this report. The form that follows helps you verify the accuracy of the report. They will reinvestigate the disputed information free of charge to you and either record the current status of the disputed information or delete the item(s) within thirty days of receiving your dispute. If the information is found to be inaccurate or incomplete or cannot be verified, they will promptly delete that item or modify it. They will provide notification of the dispute to any person who provided the information you dispute within five business days of receiving your notice of dispute. The enclosed Summary of Rights provides additional information about your rights.

You have the right to obtain an additional free copy of the enclosed report if you request it from SecurTest, Inc. within sixty days of when you receive this notice. The contact information for SecurTest is:

SecurTest, Inc.
Compliance Division
1720 Epps Bridge Parkway, Suite 108-380
Athens, GA 30606
(800) 445-8001
  • Your FCRA Rights Link (http://securtest.com/2005FCRArights.pdf)

    • All information must be completed, as it benefits you!



    Your EMAIL ADDRESS:
    You can create free emails at www.gmail.com, among other websites
    Your First Name

    Your Middle Name, if any

    Your Last Name

    Your Maiden Name, if any

    Your Social Security Number

    Your Date of Birth (mm/dd/yyyy)

    Your Street Home Street Address:

    Your City

    Your State

    Your ZIP Code:

    Your Home Phone #, if any with AREA CODE:

    Your Cell Phone #, if any with AREA CODE:

    What is the SecurHomeland Report # (which is the file name) or listed on page 1 of the report. You can also list your social security number:
    What is the name of the organization/employer or prospective employer requesting the report on page 1:


    1. Did you authorize this report? Yes   No  


    2. Does the criminal history contain some information that is your criminal history? Yes   No  


    3. Is this criminal history report completely accurate? Yes   No  


    4. I have criminal convictions that are not on this report. Yes   No  


    5. I have been convicted of a misdemeanor involving violence. Yes   No  


    6. I have been convicted of a felony involving violence. Yes   No  


    7. I have been convicted of a felony in the last 7 years. Yes   No  


    8. I am on probation or parole. Yes   No  


    9. If an applicant for employment, I no longer wish to be considered for employment and withdraw my employment application. Yes   No  


    10. Answer only if you are an applicant for employment and have a criminal record. I should be considered for employment despite my criminal record. Yes   No  


    11. I did not truthfully answer the question on the employment application about having a criminal conviction record. Yes   No  

    12. Answer this question only if you have a criminal record. Describe which criminal records by date and case #, if listed, ARE NOT yours. (We search county, state and federal courts to verify records that you say are not yours. Untruthfulness is grounds for not being hired or terminated. Type/Print in detail your answer.

    13. Answer this question only if you have a criminal record. Please explain why the employer should consider your employment application (or employment status if already employed by the employer) and what you have done to better yourself despite your past criminal record. Type in detail your answer.

    I have carefully reviewed this information and certify that it is true and correct. By clicking on Submit - Finished, I hereby indemnify and forever hold harmless SecurTest, Inc., its strategic partners, and my prospective or current employer from any and all claims arising out of my validating this information with my answers. My answers will become part of my record to help clarify, correct or validate my biographical information, which is exclusively owned by SecurTest, Inc.

    Type your FULL name as your Electronic Signature


    Customer Service Questions

    SecurTest, Inc.
    1720 Epps Bridge Parkway, Suite 108-380
    Athens, GA 30606
    800-445-8001 Toll Free
    813-888-8000
    815-550-8821 Fax
    E-Mail customerservice@securtest.com
    http://www.securtest.com

    Copyright © 2009 SecurTest, Inc. - All Rights Reserved. Patent Pending.


    (SecurHomeland and iReviewNow are copyright, trademarked, patent pending proprietary business process that may not be used or copied unless a registered customer/client of SecurTest or without written consent from the Chief Executive Officer of SecurTest, Inc.)