Company:

______

ATTN: ______

Address: ______

City:

______

State: ______Zip: ______

Please fill in the following information completely in order to receive a background check:

IPMA/IACS OFFERS POLICE BACKGROUND CHECKS

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In association with the Illinois State Police,

IPMA/IACS offers its members a background check service

HERE’S HOW IT WORKS:

Your company will provide IPMA/IACS with information on the person(s) to be checked. Please note if a women is married, to get a complete background you must run a check on her maiden name as well. A form has been included that would be filled out and faxed or emailed to the IPMA office. We would in turn send the information, via the internet, to the Illinois State Police for the background check. If the person being checked, has no record, IPMA will receive an email within 24 to 48 hours. That information will be forwarded to the requesting company. If the requested name has something pending on their record, the report will show “pending” and within 30 to 45days the pending item would be resolved with either a rap sheet of their arrests, or a no record. IPMA will forward this information to the requesting company as well.

The cost for this service is$14.00 per requested name for a background check.

SPECIAL NOTE:

According to the Illinois State Police, if a background check is being requested for employment or licensing purposes, you are required to obtain a signed release from the applicant and maintain it on file for at least two years.

This is not something that you would need to fax to IPMA. It would need to be kept for your records. A sample release form is included with this mailing that you could use for this purpose. Our attorney has looked it over to ensure that it is legal.

This should prove to be a very useful tool to you, our members, during your interviewing and hiring of new employees and at a very reasonable price.

FAX NUMBER 217-789-0222

If you need further information or have questions about our new member service, please contact Brenda at the IPMA office. The phone number is 217/241-0509 or e mail her at . She would be happy to answer any questions you might have.

Date: ______

Applicant Name:

______

Date of Birth:

______

I hereby give my permission to have my prospective employer conduct a background check on myself for purposes of consideration for employment by this company.

I understand that the results of the background check will be kept strictly confidential and used only for the consideration of employment.

Applicant Signature:

______

Employer Signature:

______

Please keep in employee record, don’t submit to IPMA