Temporary Resource – Agency Verification Form

Please enter the * required fields below.

Temporary Resource Information
Temporary Resource Name*
First Last
Pay Rate*
Bill Rate*
Estimated Start Date*
MM slash DD slash YYYY
Estimated Contract Length*
Does this temporary resource have any relatives currently employed by Encore Capital Group?*
- Yes
- No
Please list name(s) of the temporary resource’s relative(s) currently employed by Encore Capital Group*
Click "+" to include multiple relatives if needed.
Agency Information
Agency Name*
Agency Point of Contact*
Agency Phone Number*
Pre-Employment Screening Verification
SSN Trace*
- Meets Requirements
1. Felony & Misdemeanor – Last 7 years 2. Office of Foreign Assets Control (OFAC)*
1. Felony & Misdemeanor – Last 7 years *
2. Office of Foreign Assets Control (OFAC) *
- Meets Requirements
Verification of Education – Highest Degree Earned/Equivalent Work Experience*
- Meets Requirements
Verification of Employment – Last 3 Years or 2 Employers*
- Meets Requirements
Drug Screen (NDOT SAP 5-50 GC/MS)*
- Meets Requirements
Attestation
I acknowledge that the above referenced temporary resource has met the pre-employment screening requirements set forth by Encore Capital Group.*
- I attest the above to be true
Agency Representative Name*
Date*
MM slash DD slash YYYY
Send me a copy of the above (recommended)
- Send me a copy of the above (recommended)
Email copy should be sent to:
Confirm Email