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Insurance Fraud
Identifax Investigative Services
Identifax Investigative Services, Inc. Identifax Investigative Services, Inc.
Survelliance Services

ON-LINE EMPLOYMENT APPLICATION

Identifax encourages online application. Please fill in as much information as you can about you and your past history. When you are done, be sure to type your name and today's date at the bottom as your signature. Fields with an * are mandatory. Every applicant will get a reply.

APPLICANT PERSONAL INFORMATION
*Position Applied for: Surveillance Operative Direct Investigator Office Position Research
*Last Name: *First: *Middle:
*Street Address: Apartment/Unit #:
*City: *State: *Zip:
*Phone: *Email Address:
Cell Phone:
*Date Available: Social Security No.: *Desired Salary:
*Are you a citizen of
the United States?
Yes No *Are you authorized
to work in the U.S.?
Yes No  
*Have you ever worked for this company? Yes No If so, when?  
*Have you ever been convicted of a felony? Yes No If yes, explain:  
*STATE YOU WISH TO WORK IN:  

PREVIOUS EDUCATION
High
School
Address Year
Grad.
From To Did you graduate? Yes No Degree
College Address
From To Did you graduate? Yes No Degree
Other Address
From To Did you graduate? Yes No Degree

PERSONAL REFERENCES
Please list three professional references.
Full Name Relationship
Company Phone
Full Name Relationship
Company Phone
Full Name Relationship
Company Phone

PRIOR INVESTIGATIVE EXPERIENCE (IF ANY)
Licenses Held States
Years performing
Surveillance
Any Violations or
Administrative Actions?
Yes No
Years performing
Surveillance
Details of Violations
Equipment Owned 35mm Camera Video Equipment Binoculars Low Light Equip. Laptop

PREVIOUS EMPLOYMENT
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company 2 Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? Yes No
Company 3 Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? Yes No

Military Service
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain

Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I further understand that submitting this application does not guarantee either employment or a response. If this application leads to employment, I understand that false or misleading information in my application may result in my release.
*Typed Signature * Today's Date
I further understand that typing my name and date above in the SIGNATURE section constitutes my legal signature and gives authorization to IDENTIFAX or its affiliates to perform a background investigation oF me should IDENTIFAX wish to consider gainful employment with them further.



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