CIR: Carolina Investigative Research

Please enter your information below

The NC Real Estate Commission Requires the following for all license applicants:

Address/Social Security Number Verification.
Criminal Record Checks for all names and addresses either provided by applicant or discovered by the address/social security number verification.

If you have received a criminal report from Carolina Investigative Research, Inc. in the past, please provide only the addresses that have been used since your last report. If additional addresses are requested, you will be billed for the search.

If this is an update, type the word UPDATE in the comment box at the bottom of the form.

If you have lived in Georgia or Vermont within the last 7 years, you must download the proper release form and fax it to our office in addition to completing the following online form OR you must submit the printable form via fax or mail.

CIR'S PRIVACY POLICY

Results are returned via email, fax or US. You should receive an email receipt from us after submitting your information-if you do not, there is problem with your email address. We will have difficulty in sending your report to you through our automated system.


Required for Search and Retrieval

eMail Address
Daytime Phone
Fax Number
I don't have email or fax

Credit Card #
Expiration Date	/
Credit Card Type
Name on Credit Card (Ex: John W. Smith)

Search Information

First Name
Middle Name
Last Name
Suffix
Sex	Male Female

Date of Birth	/ /
Social Security #
Driver's License #
State of Issuance

List ANY name used and provide the month and year when used:

Maiden names, other married names, alias, aka's (As Known As) fka, (Formerly Known As), nicknames, legal change of names, etc. will be searched. Hyphenated surnames, such as John Smith-Jones, will be searched as John Smith-Jones, John Smith, and John Jones. Please provide as accurate date as possible as to when and where a name was used. YOU WILL BE CHARGED FOR EACH NAME SEARCHED IN EACH JURISDICTION. We do not want to conduct searches where a name was not used, accurate dating will help us. We try to provide lower pricing for aka's. Your estimated cost may not reflect all alias searches that will be performed. If you need an accurate cost, please send us an email requesting "price with aka fees".

Full Name
Dates: From To

Full Name
Dates: From To

Full Name

Dates: From

List ALL addresses for the last 7 years. If you omit any address or date, your background check will be delayed.

	Current Address
Dates: From To	Present
Street Address
City
County
State/Province
Zip Code

Previous Address 1

	Previous Address 2
Dates: From To
Street Address
City
County
State/Province
Zip Code

Previous Address 3

	Previous Address 4
Dates: From To
Street Address
City
County
State/Province
Zip Code

Previous Address 5

	If you have additional addresses, please place the city and state below:
	City
	City
	City

		A Federal Record Search is not required by the North Carolina Real Estate Commission. However, the Commission may, at its expense, perform a Federal Record Search. If you have ever had a federal conviction or have a pending federal charge, the Commission recommends that you obtain a Federal Record Search to assist you in accurately reporting your criminal convictions. Please check this box if you would like to have a Federal Record Search performed at an additional expense of $15.00.

		Comments/Special Instructions:

Important: WE WILL NOT PROCESS THIS REQUEST, WITHOUT ELECTRONIC SIGNATURE (OR A SIGNED RELEASE)

I hereby state that the information I have provided to Carolina Investigative Research (CIR) is true and correct. I authorize CIR to conduct a criminal record search and address trace on myself. I authorize electronic release of the background report to the North Carolina Real Estate Commission. I acknowledge that the North Carolina Real Estate Commission will have access to the completed report.

Electronic Signature,

By typing my name I acknowledge this is my legal mark.

Please verify your email address and phone number

are correct before submitting this form!!!

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