GDFGlobal Data Fusion, LLC
P.O. Box 53889
Lafayette, LA 70505-3889
337-205-3007
support@globaldatafusion.com

 

Background Investigation Authorization & Instructions

In connection with your application for employment/residency with Qualis Care, LLC, you have agreed to authorize a background investigation. To ensure that your rights are protected, this investigation will be conducted by the following Consumer Reporting Agency:

Global Data Fusion, LLC
1018 Harding Street Ste. 209
P.O. Box 53889
Lafayette, LA 70505-3889

Phone: 337-205-3007

This investigation will be conducted in compliance with federal law, which provides specific protection to you, as stated in the following document: Summary of Your Rights Under the Fair Credit Reporting Act (FCRA) prepared pursuant to 15 U.S.C. Section 1681-1681u.

Click here now to read the above mentioned document.

During this application process, you will be asked to sign an FCRA Compliant GENERAL RELEASE form authorizing this background investigation by Global Data Fusion, LLC. Failure to complete this process will disqualify you from consideration for employment/residency. If you have any questions about the process or your rights in this matter, please contact Qualis Care LLC directly.

To proceed, fill in the information requested below then click on the NEXT button:


 
First NamePlease no Nicknames or Initials
Middle NameFull Middle Name or Initial
Last NameFamily Name
SuffixExample Jr., III etc.
Street AddressCurrent Full Street Address
CityCurrent City of Residence
StateCurrent State of Residence
Zip Code
SSN999999999 or 999-99-9999 format
Birth Date (DOB)MMDDYYYY format or MM/DD/YYYY format
Drivers License NumberInclude all Numerals
Issuing StateState of Issue
Cell Phone NumberPlease provide your mobile phone number if you have one
Email AddressPlease provide your current email address
Raceex: black,white, other
Genderex: male, female
 
 
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