Employee/Applicant Name: _____________________________________________________
Other Names Used: ____________________________________________________________
DOB: ____________________ POB: _______________________ SSN: __________________


 Current Address: _____________ City: ___________ State: ___ Zip: ______ How Long: ______
Previous Address: _____________ City: ___________ State: ___ Zip: ______ How Long: ______
Previous Address: _____________ City: ___________ State: ___ Zip: ______ How Long: ______

Driving License Number and State (Please ensure accuracy): _________________________________

Screening Requested:

__ County Criminal Profile     __ Education Verification  __ Civil Profile
__ State Wide Criminal Profile __ Employment Verif.       __ Professional Licensing
__ Driving History             __ Worker's Compensation   __ Residence Verification
__ Credit Profile              __ Child Abuse Name Verification - Where Applicable.
__ SSN Trace

Authorization Release

I, __________________, born at ___________________________ on _____________ having
        (Name)                   (City, State, Country)           (Date)
filed an application for employment in the position of _______________________ at
                                                               (Title)
________________________ hereby apply for a background report and consent to have an
  (Company/Household)
investigation made as to my character, professional reputation and fitness for the
position I have applied for and such other information as may be received, all of
which will be reported to _____________________________.
                                (Company/Household)
I hereby agree to give any other further information which may be required 
concerning my past record. I understand that the contents of my background report
are confidential.

I also authorize and request every person, firm, company, corporation, government
agency, law enforcement agency, court, association or institute having control of
any documents, records or other information pertaining to me, to furnish to
Graham/Sheehan Security Services, Inc. any such information, including documents,
records, and files, whether formal or informal, pending or closed, or any other
pertinent data; and to permit Graham/Sheehan Security Services, Inc., or any of its
agents or representatives to inspect and make copies of such documents, records,
files, or other information.

I hereby release, discharge, and exonerate Graham/Sheehan Security Services, Inc.,
its agents and representatives and any person so furnishing information from any and
all liability of every nature an kind arising out of the furnishing or inspection
of such documents, records, files and other information or the investigation made
by Graham/Sheehan Security Services, Inc.

I have read the foregoing document and I have answered all the questions with 
respect to my application for a background report fully and frankly. The answers 
are complete and true of my own knowledge and I affix my signature hereto freely 
and voluntarily.

______________________________     ___________________     ___________________________
  (Signature of Applicant)                (Date)               (Witness Signature)    

County Criminal Profile: _____________________________________________________________
                          (List counties to be checked in addition to the two already
                           included under above addresses.)

State-Wide Criminal Profile: _________________________________________________________
                              (List states to be checked. See state-wide schedule for
                               cost and processing time.)