app.justifacts.com
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107.154.76.22
Public Scan
Submitted URL: https://app.justifacts.com/JFACTS/servlet/employment.EmpAutoLink?sid=1994931&oid=3715288&eType=1&t1=13563&t2=16646&t3=30780...
Effective URL: https://app.justifacts.com/JFACTS/servlet/employment.EmpAutoSearchForm?sid=1994931&oid=3715288&eType=1&t1=13563&t2=16646&t3...
Submission: On August 11 via manual from US — Scanned from DE
Effective URL: https://app.justifacts.com/JFACTS/servlet/employment.EmpAutoSearchForm?sid=1994931&oid=3715288&eType=1&t1=13563&t2=16646&t3...
Submission: On August 11 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: dataform — POST
<form name="dataform" id="dataform" action="" method="POST">
<table id="OUTERTBL" name="OUTERTBL" border="0" width="90%" style="margin-left:auto; margin-right:auto;">
<tbody>
<tr>
<td align="CENTER">
<div id="autoSearchFormContainer">
<div class="blue-table" id="autoSearchFormHeader" style="width:90%; margin-left:auto; margin-right:auto;">
<div class="flex-row">
<div class="header-cell">KFC EMPLOYMENT FORM</div>
</div>
<div class="flex-row">
<div class="cell">
<h2>Applicant Name: Mayer, Dhalise</h2>
</div>
</div>
<div class="flex-row">
<div class="cell">
<h2> Name While Employed: Dhalise </h2>
</div>
</div>
<div class="flex-row">
<div class="cell">
<p> We are attempting to verify employment on the applicant named above. This individual has identified you as a former employer. In order to assist with his/her background check, please complete the following information.</p>
<input type="hidden" id="usedButton" name="usedButton" value="0">
<input type="hidden" id="sidForm" name="sidForm" value="1994931">
<input type="hidden" id="oidForm" name="oidForm" value="3715288">
<input type="hidden" id="eTypeForm" name="eTypeForm" value="1">
<input type="hidden" id="t1Form" name="t1Form" value="13563">
<input type="hidden" id="t2Form" name="t2Form" value="16646">
<input type="hidden" id="t3Form" name="t3Form" value="30780">
<input type="hidden" id="t4Form" name="t4Form" value="2656">
<input type="hidden" id="t5Form" name="t5Form" value="446097">
<input type="hidden" id="expForm" name="expForm" value="JsJsJsElAmMoGzIrDzMoDzDzMo">
<input type="hidden" name="browser" id="browser" value="safari 537.36">
<input type="hidden" name="os" id="os" value="win unknown">
</div>
</div>
<div class="flex-row">
<div class="cell">
<a href="./bgcRequest.ViewBackgroundInvestigationWaiver?XnSmOt1OYIg1sY01OwRh8urwayCDAciaVpkJcOgeltltJWNmr7kYblw6LBgz9Dqh3CPYpQE3TAsst0ja6ZKfrS_43SivQtx8z5OGtFica6ulP_43Xq1eX5oMyXoIduvtexNiE1fvgrDXy0WS76_439_43TwKSA_47gFjK9GtXW1Dz209ejzkXm2BbilFoRvf_47a5qUWpabuKFtBBdMJrhyqQfoOoSKklKLsQtdciR10" target="_blank" title="View Waiver">Click Here To View Authorization Waiver</a>
</div>
</div>
</div>
<div class="blue-table header-on-left" id="autoSearchFormQuestions" style="width:90%; margin-left:auto; margin-right:auto;">
<div class="flex-row">
<div class="cell" style="width:100%;">
<h2>Employer/Respondent Current Information</h2>
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Your Full Name<star>*</star>
</div>
<div class="cell" style="width:65%;">
<input required="" id="RespondentName" name="RespondentName" type="text" size="50" maxlength="99" value="Samia durpreist">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Your Job Title<star>*</star>
</div>
<div class="cell" style="width:65%;">
<input required="" id="RespondentJobTitle" name="RespondentJobTitle" type="text" size="50" maxlength="99" value="General manger">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Your Company's Address</div>
<div class="cell" style="width:65%;">
<input id="RespondentLocation" name="RespondentLocation" type="text" value="Philadelphia, PA" size="50" maxlength="200">
</div>
</div>
<br>
<div class="flex-row">
<div class="cell" style="width:100%;">
<h2>Employment Information</h2>
<div class="checkbox" '="">
<input type="checkbox" id="ckbxWrongContactBasic" name="ckbxWrongContactBasic" value="true" onclick="javascript: toggleChangeContactBasic(' 1');">
<label for="ckbxWrongContactBasic" style="font-size:100%; color:red;"><b>I am not the proper person to provide this information</b></label>
</div>
</div>
</div>
<div id="changeContactBasic" style="display:none;">
<div class="flex-row">
<div class="cell" style="width:100%;">
<h2 style="color:red;"><b>Please provide the details for an alternate contact who will provide the Employment Information:</b></h2>
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Full Name<star>*</star>
</div>
<div class="cell" style="width:65%;">
<input required="" id="changeContactBasicRespondentName" name="changeContactBasicRespondentName" type="text" size="50" maxlength="99" value="">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Title</div>
<div class="cell" style="width:65%;">
<input required="" id="changeContactBasicRespondentTitle" name="changeContactBasicRespondentTitle" type="text" size="50" maxlength="99" value=" ">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Email<star>*</star>
</div>
<div class="cell" style="width:65%;">
<input id="changeContactBasicRespondentEmail" name="changeContactBasicRespondentEmail" type="text" value="" size="50" maxlength="200">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Phone</div>
<div class="cell" style="width:65%;">
<input id="changeContactBasicRespondentPhone" name="changeContactBasicRespondentPhone" type="text" value="" size="50" maxlength="200">
</div>
</div>
</div>
<div id="basicQuestions">
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align:right;"> Applicant Start and End Dates (Time Span A) </div>
<div class="cell" style="width:65%;">
<table>
<tbody>
<tr>
<th class="applicantEnteredDates" colspan="100%">Applicant Entered Dates (Time Span A)</th>
</tr>
<tr>
<th class="applicantEnteredDates">Start</th>
<th class="applicantEnteredDates">End</th>
</tr>
<tr>
<td class="applicantEnteredDates">04 / 2019</td>
<td class="applicantEnteredDates">07 / 2022</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<th class="employerEnteredDates" colspan="100%"> Employer Entered Dates (Time Span A) </th>
</tr>
<tr>
<th class="employerEnteredDates">Start</th>
<td class="employerEnteredDates" style="text-align: left;">
<i>Month</i>:<select id="theMonth" type="TEXT" name="startMonth_A">
<option value="0" selected="">Please select</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<i>Day</i>:<select id="theMonth" type="TEXT" name="startDayOfMonth_A">
<option value="0" selected="">Please select</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<i>Year</i>:<select id="theYear" type="TEXT" name="startYear_A">
<option value="0" selected="">Please select</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
</select>
</td>
</tr>
<tr>
<th class="employerEnteredDates">End</th>
<td class="employerEnteredDates" style="text-align: left;">
<div id="endDateDiv_A">
<i>Month</i>:<select id="theMonth" type="TEXT" name="endMonth_A">
<option value="0" selected="">Please select</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<i>Day</i>:<select id="theMonth" type="TEXT" name="endDayOfMonth_A">
<option value="0" selected="">Please select</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<i>Year</i>:<select id="theYear" type="TEXT" name="endYear_A">
<option value="0" selected="">Please select</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
</select>
</div>
<br>
<label>
<input type="checkbox" value="true" id="isPresentEmployment_A" name="isPresentEmployment_A" onchange="javascript: toggleEndDateDiv('A');">
<i>Check here if currently employed</i>
</label>
<br>
<label>
<input type="checkbox" value="true" id="isDateRangeNotAvailable_A" name="isDateRangeNotAvailable_A" onchange="javascript: toggleDateRangeNotAvailable('A');">
<i>Check here if these dates are not available</i>
</label>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<script type="text/javascript">
function isValidTimeSpan_A() {
var isEntered = isEnteredStartAndEndDate('A');
if (!isEntered) {
alert('Start and End Date are required for Time Span A');
return false;
} else {
return true;
}
}
</script>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Applicant Job Title</div>
<div class="cell" style="width:65%;">
<textarea wrap="virtual" id="JobTitleSA" name="JobTitleSA" rows="2" cols="80" onkeydown="tareaCount('counterJobTitleSA',this,250);" onkeyup="tareaCount('counterJobTitleSA',this,250);"
onchange="tareaCount('counterJobTitleSA',this,250);" onblur="tareaCount('counterJobTitleSA',this,250);"> </textarea><span style="font-size:10px;" id="counterJobTitleSA">250 Characters Available</span>
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">Applicant Reason for Leaving</div>
<div class="cell" style="width:65%;">
<textarea wrap="virtual" id="txtReasonSup" name="txtReasonSup" rows="2" cols="80" onkeydown="tareaCount('counter_txtReasonSup',this,525);" onkeyup="tareaCount('counter_txtReasonSup',this,525);"
onchange="tareaCount('counter_txtReasonSup',this,525);" onblur="tareaCount('counter_txtReasonSup',this,525);"> </textarea><span style="font-size:10px;" id="counter_txtReasonSup">525 Characters Available</span>
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;"> Would you rehire? </div>
<div class="cell" style="width:65%;">
<input id="txtBasicRehire" type="TEXT" name="txtBasicRehire" class="form-group" value="" maxlength="15">
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align: right;">If not, why?</div>
<div class="cell" style="width:65%;">
<textarea wrap="virtual" id="txtBasicRehireExplain" name="txtBasicRehireExplain" rows="2" cols="80" onkeydown="tareaCount('countertxtBasicRehireExplain',this,750);" onkeyup="tareaCount('countertxtBasicRehireExplain',this,750);"
onchange="tareaCount('countertxtBasicRehireExplain',this,750);" onblur="tareaCount('countertxtBasicRehireExplain',this,750);"> </textarea><span style="font-size:10px;" id="countertxtBasicRehireExplain">750 Characters
Available</span>
</div>
</div>
<div class="flex-row">
<div class="header-cell" style="width:35%; text-align:right;">If any information was not provided, please check why?</div>
<div class="cell" style="width:65%;">
<p>
<input type="radio" id="BASIC_NOTANSWERED" name="BASIC_NOTANSWERED" value="1"> Per company policy <input type="radio" id="BASIC_NOTANSWERED" name="BASIC_NOTANSWERED" value="3"> Information was purged<br>
<input type="radio" id="BASIC_NOTANSWERED" name="BASIC_NOTANSWERED" value="2"> Lack of records <input type="radio" id="BASIC_NOTANSWERED" name="BASIC_NOTANSWERED" value="4"> Not privy to this information
</p>
</div>
</div>
</div>
</div>
<br>
<div id="BUTTONS" name="BUTTONS">
<input type="button" id="FormsButton9" name="btnSubmit" value="Click Here to Submit and Complete Form" onclick="javascript:
if (dataform.usedButton.value != '1') {
var v_isWrongContact = isWrongContact();
if ( ! v_isWrongContact) {
if (typeof isValidTimeSpan_A === 'function') {
if ( ! isValidTimeSpan_A()) {
return false;
}
}
if (typeof isValidTimeSpan_B === 'function') {
if ( ! isValidTimeSpan_B()) {
return false;
}
}
if (typeof isValidTimeSpan_C === 'function') {
if ( ! isValidTimeSpan_C()) {
return false;
}
}
}
if (validateRequired('1')) {
dataform.usedButton.value='1';
this.disabled=true;
dataform.action='./employment.EmpAutoSubmitForm?sid=1994931&oid=3715288&eType=1&t1=13563&t2=16646&t3=30780&t4=2656&exp=JsJsJsElAmMoGzIrDzMoDzDzMo&t5=446097';
dataform.submit();
}
} ">
</div>
<br>
</div>
</td>
</tr>
</tbody>
</table>
</form>Text Content
KFC EMPLOYMENT FORM APPLICANT NAME: MAYER, DHALISE NAME WHILE EMPLOYED: DHALISE We are attempting to verify employment on the applicant named above. This individual has identified you as a former employer. In order to assist with his/her background check, please complete the following information. Click Here To View Authorization Waiver EMPLOYER/RESPONDENT CURRENT INFORMATION Your Full Name* Your Job Title* Your Company's Address EMPLOYMENT INFORMATION I am not the proper person to provide this information PLEASE PROVIDE THE DETAILS FOR AN ALTERNATE CONTACT WHO WILL PROVIDE THE EMPLOYMENT INFORMATION: Full Name* Title Email* Phone Applicant Start and End Dates (Time Span A) Applicant Entered Dates (Time Span A) Start End 04 / 2019 07 / 2022 Employer Entered Dates (Time Span A) Start Month:Please selectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day:Please select12345678910111213141516171819202122232425262728293031 Year:Please select20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923 End Month:Please selectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day:Please select12345678910111213141516171819202122232425262728293031 Year:Please select20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923 Check here if currently employed Check here if these dates are not available Applicant Job Title 250 Characters Available Applicant Reason for Leaving 525 Characters Available Would you rehire? If not, why? 750 Characters Available If any information was not provided, please check why? Per company policy Information was purged Lack of records Not privy to this information