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Services | Sample Professional License Verification Report
Confidential - For Exclusive use by : Your Company, Inc. 

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Information contained herein should not be the sole determination in evaluating 
this individual. All other available information should be considered. 
Human error in compiling this information is possible and Background Source Intl. 
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actions if you take adverse action based in whole or in part on this report.

------------------------- PROFESSIONAL LICENSE VERIFICATION ---------------------
Name...................: SAMPLE REPORT
Social Security #......: 444-44-4444
_________________________________________________________________________

_______________________STATE OF NY - Lic Practical Nurse_____________________

License#...............: 1234567
Origination Date.......: NONE PROVIDED
Expiration Date...,....: 10/31/99
Status.................: CURRENT / ACTIVE
Disciplinary Actions...: NONE PROVIDED
 Verified by...........: NY BOARD OF NURSING
Title..................: AUTOMATED SYSTEM
Phone..................: (555) 555-5555

Entered by ............: KSS
Date...................: 04/06/01
Confirmed by...........: NAME AND LICENSE NUMBER #1234567
Comments...............: LAPSED LICENSED PRACTICAL NURSE 
                         LICENSE WHICH EXPIRED 10/31/94

                              --- End of Report ---