Enroll Now TEAM Professional Services Thank you for choosing TEAM to help manage your drug and alcohol testing program! Complete this form and a member of our Implementation TEAM will be in contact within 24 hours. NOTE: The Annual Membership Fee is $350. The first year’s membership fee will be due at the end of this form. We look forward to serving as your partner in workplace compliance! Step 1 of 7 - Getting Started 14% You will need the following information to complete this form: Company Information Employee Information Download .XLS Template Statistical Data (if you’ve completed random testing during the current year) Download .XLS Template (Non-DOT Stat Data) Download .XLS Template (PHMSA Stat Data) Download .XLS Template (FMCSA Stat Data) Company InformationLegal Company Name* Doing Business As Phone Number*Fax NumberPhysical Address*Note: a P.O. Box is NOT acceptable for a physical address. Please enter your P.O. Box under the next question for Mailing Address. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your Mailing Address different from your Physical Address?* Yes No Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Industry*Select all that apply.Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherNorth American Industrial Classification (NAICS)If known, select one from the below list.######111110111120111130111140111150111160111191111199111211111219111310111320111331111332111333111334111335111336111339111411111419111421111422111910111920111930111940111991111992111998112111112112112120112130112210112310112320112330112340112390112410112420112511112512112519112910112920112930112990113110113210113310114111114112114119114210115111115112115113115114115115115116115210115310211120211130212111212112212113212210212221212222212230212291212299212311212312212313212319212321212322212324212325212391212392212393212399213111213112213113213114213115221111221112221113221114221115221116221117221118221121221122221210221310221320221330236115236116236117236118236210236220237110237120237130237210237310237990238110238120238130238140238150238160238170238190238210238220238290238310238320238330238340238350238390238910238990311111311119311211311212311213311221311224311225311230311313311314311340311351311352311411311412311421311422311423311511311512311513311514311520311611311612311613311615311710311811311812311813311821311824311830311911311919311920311930311941311942311991311999312111312112312113312120312130312140312230313110313210313220313230313240313310313320314110314120314910314994314999315110315190315210315220315240315280315990316110316210316992316998321113321114321211321212321213321214321219321911321912321918321920321991321992321999322110322121322122322130322211322212322219322220322230322291322299323111323113323117323120324110324121324122324191324199325110325120325130325180325193325194325199325211325212325220325311325312325314325320325411325412325413325414325510325520325611325612325613325620325910325920325991325992325998326111326112326113326121326122326130326140326150326160326191326199326211326212326220326291326299327110327120327211327212327213327215327310327320327331327332327390327410327420327910327991327992327993327999331110331210331221331222331313331314331315331318331410331420331491331492331511331512331513331523331524331529332111332112332114332117332119332215332216332311332312332313332321332322332323332410332420332431332439332510332613332618332710332721332722332811332812332813332911332912332913332919332991332992332993332994332996332999333111333112333120333131333132333241333242333243333244333249333314333316333318333413333414333415333511333514333515333517333519333611333612333613333618333912333914333921333922333923333924333991333992333993333994333995333996333997333999334111334112334118334210334220334290334310334412334413334416334417334418334419334510334511334512334513334514334515334516334517334519334613334614335110335121335122335129335210335220335311335312335313335314335911335912335921335929335931335932335991335999336111336112336120336211336212336213336214336310336320336330336340336350336360336370336390336411336412336413336414336415336419336510336611336612336991336992336999337110337121337122337124337125337127337211337212337214337215337910337920339112339113339114339115339116339910339920339930339940339950339991339992339993339994339995339999423110423120423130423140423210423220423310423320423330423390423410423420423430423440423450423460423490423510423520423610423620423690423710423720423730423740423810423820423830423840423850423860423910423920423930423940423990424110424120424130424210424310424320424330424340424410424420424430424440424450424460424470424480424490424510424520424590424610424690424710424720424810424820424910424920424930424940424950424990425110425120441110441120441210441222441228441310441320442110442210442291442299443141443142444110444120444130444190444210444220445110445120445210445220445230445291445292445299445310446110446120446130446191446199447110447190448110448120448130448140448150448190448210448310448320451110451120451130451140451211451212452210452311452319453110453210453220453310453910453920453930453991453998454110454210454310454390481111481112481211481212481219482111482112483111483112483113483114483211483212484110484121484122484210484220484230485111485112485113485119485210485310485320485410485510485991485999486110486210486910486990487110487210487990488111488119488190488210488310488320488330488390488410488490488510488991488999491110492110492210493110493120493130493190511110511120511130511140511191511199511210512110512120512131512132512191512199512230512240512250512290515111515112515120515210517311517312517410517911517919518210519110519120519130519190521110522110522120522130522190522210522220522291522292522293522294522298522310522320522390523110523120523130523140523210523910523920523930523991523999524113524114524126524127524128524130524210524291524292524298525110525120525190525910525920525990531110531120531130531190531210531311531312531320531390532111532112532120532210532281532282532283532284532289532310532411532412532420532490533110541110541120541191541199541211541213541214541219541310541320541330541340541350541360541370541380541410541420541430541490541511541512541513541519541611541612541613541614541618541620541690541713541714541715541720541810541820541830541840541850541860541870541890541910541921541922541930541940541990551111551112551114561110561210561311561312561320561330561410561421561422561431561439561440561450561491561492561499561510561520561591561599561611561612561613561621561622561710561720561730561740561790561910561920561990562111562112562119562211562212562213562219562910562920562991562998611110611210611310611410611420611430611511611512611513611519611610611620611630611691611692611699611710621111621112621210621310621320621330621340621391621399621410621420621491621492621493621498621511621512621610621910621991621999622110622210622310623110623210623220623311623312623990624110624120624190624210624221624229624230624310624410711110711120711130711190711211711212711219711310711320711410711510712110712120712130712190713110713120713210713290713910713920713930713940713950713990721110721120721191721199721211721214721310722310722320722330722410722511722513722514722515811111811112811113811118811121811122811191811192811198811211811212811213811219811310811411811412811420811430811490812111812112812113812191812199812210812220812310812320812331812332812910812921812922812930812990813110813211813212813219813311813312813319813410813910813920813930813940813990814110921110921120921130921140921150921190922110922120922130922140922150922160922190923110923120923130923140924110924120925110925120926110926120926130926140926150927110928110928120Operators & Hiring ClientsDo you contract for any Operator clients that require drug & alcohol testing?* Yes No If yes, please specify*Clinic LocationsPrimary Clinic Location*Please list your company’s primary location where you will need a collection facility set up to perform testing for your employees. Same as Physical Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Specific Clinic RequestsIf you'd like to request additional locations for testing and/or any specific clinic(s), please list each site's information below. If no specific clinic is listed, TEAM will set you up with one of our preferred collection sites in the area(s) you specify.Clinic NameCityStateZip Add RemoveHiddenZIP Code*Old Field - Hidden to save entries* HiddenClinic Locations*Old Field - Hidden to save entries*CityStateZIP Add Remove Primary ContactFull Name* First Last Suffix Email Address*Note: the email address listed will be your username for our online ordering system. Enter Email Confirm Email Phone Number*Can this user receive background check reports?* Yes No N/A Secondary ContactSecondary Contact Full Name First Last Suffix Secondary Contact Email Address*Note: the email address listed will be your username for our online ordering system. Enter Email Confirm Email Secondary Contact Phone Number*Can this user receive background check reports?* Yes No N/A Billing ContactIs the billing contact the same as the Primary contact?* Yes No Billing Contact Full Name* First Last Suffix Billing Contact Email Address*Note: the email address listed will be your username for our online ordering system. Enter Email Confirm Email Billing Contact Phone Number* Employee InformationEmployee Roster*Please provide your employee roster by uploading the template or manually entering the employees’ information. Be sure to include all employees in your company that need to be subject to random drug and alcohol testing. Upload Roster File Manually Enter Roster Download .XLS TemplateUpload Roster File*Accepted file types: xls, xlsx, csv, Max. file size: 256 MB.Manually Enter Roster*First NameLast NameSuffixEmployee IDClassificationHas the Employee had a Pre-Employment Drug Test?Has the employee been subject to random testing in the past 30 days? Non-DOTFMCSAPHMSAOtherYesNoYesNo Add RemoveHave all of your employees completed a pre-employment drug test?* Yes No In the past 30 days, have your DOT employees completed a pre-employment drug test or been subject to random testing?*Per DOT regulation, if an employee has not been subject to random testing or had a pre-employment drug screen in the past 30 days, they will have to complete a pre-employment drug test before they can be added to a random drug testing pool or consortium. If your employees will need to complete pre-employment drug tests, these can be processed through TEAM once your account setup is complete. Yes. All of my DOT employees have had a pre-employment drug test in the past 30 days. Yes. All of my DOT employees have been subject to random testing in the past 30 days. No. My DOT employees have not had a pre-employment drug test in the past 30 days, nor have they been subject to random testing in the past 30 days. I do not have DOT employees Have you completed any random testing for the current year?* Yes No If you’ve completed FMCSA random testing this year, download the below template to provide your FMCSA statistical data.Download .XLS TemplateAccepted file types: xls, xlsx, csv, Max. file size: 256 MB.If you’ve completed PHMSA random testing this year, download the below template to provide your PHMSA statistical data.Download .XLS TemplateAccepted file types: xls, xlsx, csv, Max. file size: 256 MB.If you’ve completed non-DOT random testing this year, download the below template to provide your non-DOT statistical data.Download .XLS TemplateAccepted file types: xls, xlsx, csv, Max. file size: 256 MB. ServicesWould you like TEAM to manage occupational services for you?* Yes No Please select which services you would like TEAM to manage* DOT Physicals Pre-Placement/Pre-Employment Physicals (non-DOT) Pulmonary Function Tests (PFT) Audiogram Respirator Fit Testing TB Testing X-Rays Vision Testing Other Select AllPlease specify additional services* Would you like to enroll your supervisors in TEAM’s self-paced, webinar reasonable suspicion training?*$49/registrant. Note: Per DOT regulation, all persons designated to supervise drivers of commercial motor vehicles are required to complete a Reasonable Suspicion training course (49 CFR §382.603). Yes No Please list your supervisors' information and select a training courseFirst NameLast NamePhoneEmailTraining Course DOT Reasonable Suspicion Training for Supervisors ($49/Supervisor)Non-DOT Reasonable Suspicion Training for Supervisors ($49/Supervisor) Add RemoveWould you like to use TEAM Background, LLC, as your background check provider?*Click here to view a list of services and pricing offered by TEAM Background. Yes No Background Checks Performed Annually*Please provide an estimate of how many background checks your company anticipates performing per year.Please enter a number greater than or equal to 1.Standard Packages Silver Background PackageNationwide Criminal & Sex Offender Registry Database SearchSocial Security (SSN) TraceSingle County Criminal Record Search (Current County of Residence) Platinum Background Package RecommendedNationwide Criminal & Sex Offender Registry Database SearchSocial Security (SSN) Trace7-Year County Criminal Record Search FMCSA Packages Silver FMCSA Background Package (Minimum FMCSA Requirements)Motor Vehicle Record (MVR)3-Year DOT Employment VerificationFMCSA Clearinghouse Full Query Platinum FMCSA Background PackageMotor Vehicle Record (MVR)3-Year DOT Employment VerificationFMCSA Clearinghouse Full QueryNationwide Criminal & Sex Offender Registry Database SearchSocial Security (SSN) Trace7-Year County Criminal Record Search PHMSA Packages Silver PHMSA Background PackageMotor Vehicle Record (MVR)2-Year DOT Employment Verification Platinum PHMSA Background PackageMotor Vehicle Record (MVR)2-Year DOT Employment VerificationNationwide Criminal & Sex Offender Registry Database SearchSocial Security (SSN) Trace7-Year County Criminal Record Search Custom Package Custom Package If selecting this option, a member of our Implementation TEAM will reach out to you to configure a custom package for your account.à La Carte ServicesChoose any "à la carte" options you would like to order in addition to the above package(s). Employment Verification Education Verification Professional Reference Verification Personal Reference Verification E-Verify Search(Electronic I-9 Verification Capture available for an additional $10 per case) Motor Vehicle Record (MVR) FMCSA Clearinghouse Limited Queries Other Select AllPlease specify additional services*HiddenIf YES, which package(s)? (You can change your plan type later)* Standard Background Check (Non-DOT) – $14.50*National Criminal & Sex Offender Search, County Criminal Search and Social Security Verification Expanded Background Check (Non-DOT) – $32.00*7-year County Criminal Search, National Criminal & Sex Offender search and Social Security Verification with Address History Standard DOT Background Package (FMCSA or PHMSA) – $4.25 + $7.25/Employer*Motor Vehicle Report and 3 Year Employment Verification with Drug & Alcohol History Expanded DOT Background Check (FMCSA or PHMSA) - $23.50 + $7.25/Employer*2-3 Year Employment Verification with Drug & Alcohol History, Motor Vehicle Report, National Criminal & Sex Offender Search, County Criminal Search and Social Security Verification Hazmat DOT Background Check (FMCSA or PHMSA) - $36.25 + $7.25/Employer*Motor Vehicle Record, 3-year Employment Verification, 3-year Drug and Alcohol Test History Verification, National Criminal & Sex Offender Search, 7-year County Criminal Search based on Person Search, Social Security Verification & Address History Report *Excludes county, state, employer and institution access fees *Old Field - Hidden to save entries*HiddenChoose any "À la carte" options you would like to order in addition to the above package(s) Worker’s Comp History – $6.00*Search for Worker’s Comp Claims in requested state Education Verification – $7.25/Institution*Verify Degree or certificate with requested institution 1-9 Verification – $7.00E-Verify Employment Eligibility and SSN Verification State MVR check – $4.25*Motor Vehicle Report with State Non-DOT Employment Verification – $7.25/Employer*Verify Previous or current Employer *Excludes county, state, employer and institution access fees *Old Field - Hidden to save entries* How did you hear about TEAM?* Google Search Social Media Marketing Email Advertisement Conference or Tradeshow Contacted by Salesperson Referral Existing Customer Other Referral Details*Please list the name of the TEAM Salesperson, company, or other individual that referred you. If you selected "Conference or Tradeshow", list the name of the event. You can also use this field to provide details if you selected "Other". Billing InformationOne-Time Enrollment Fee* Price: Promo Code HiddenCoupon Code*OLD FIELD - Hidden to keep entires* Amount Due Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Exp. Month010203040506070809101112 Year Exp. Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Confirmation* I confirm that all information provided in this form is true, complete and accurate to the best of my knowledge. Name* First Last Suffix Today's Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Service AgreementIn order to receive background screening services from TEAM Background, LLC, the primary user for your company's account must review, accept, and sign our Service Agreement. After you submit this form, you will receive an email from noreply@teamprofessional.com with a link to sign and submit the agreement online. To ensure you receive this email, please add us to your address book.CommentsThis field is for validation purposes and should be left unchanged. Δ