PNW WEB DESIGNERS & MARKETING

Background Check &
Applicant Information

Please complete all applicable information below.

Applicant Information

Please provide your current information.

Full Legal Name *

Email Address *

Phone Number *

Current Street Address *

City *

State *

ZIP Code *

Date of Birth *

Last 4 Digits of Social Security Number *

Enter only the last four digits of your Social Security number.

Employment History

Please provide information for up to three recent employers.

Employer 1

Company Name *

Position / Job Title

Years Worked

Reason for Leaving

Employer 2

Company Name

Position / Job Title

Years Worked

Reason for Leaving

Employer 3

Company Name

Position / Job Title

Years Worked

Reason for Leaving

Computer & Technology Experience

Tell us about the technology and software you currently know how to use.

Computer Programs, Software & Technology Skills *

AI Platforms & Experience

We would like to understand your current experience with artificial intelligence tools.

What AI platforms or AI-powered tools are you currently using today?

How comfortable are you learning new AI or technology platforms?

Identification Upload

Please upload a clear photo or scan of your identification.

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Upload Identification

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Authorization & Acknowledgment

Please review the statement below before signing.

I certify that the information I have provided on this form is true and complete to the best of my knowledge.

I understand that PNW Web Designers & Marketing may use the information provided on this form as part of its contractor screening and verification process.

I authorize PNW Web Designers & Marketing to verify information provided by me as permitted by applicable law and as necessary for the screening process.

I understand that submitting this form does not guarantee that I will receive a project, contract assignment, or other engagement with PNW Web Designers & Marketing.

I have read and agree to the authorization and acknowledgment above.

Full Legal Name *

Date *

Draw Your Signature *

Please review your information before submitting.

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Thank You

Your information has been successfully submitted.

PNW Web Designers & Marketing has received your information.

PNW WEB DESIGNERS & MARKETING

Background Check &Applicant Information

Applicant Information

Employment History

Computer & Technology Experience

AI Platforms & Experience

Identification Upload

Upload Identification

Authorization & Acknowledgment

Thank You

Background Check &
Applicant Information