Request A Reference Number

Middle Initial: *Last Name:

Date of Birth:

*Month: *Day: *Year: (Used to verify your identity and make sure unauthorized updates are not made to your file.)

Please be sure to enter all phone numbers in the following format: 7132282200.

Home Phone: Work Phone: Extension:

Cell Phone: Alternate:

RGIS Employment Info

*What is your current employment status with RGIS?
(If you still work for RGIS select "Current Employee" otherwise select "Former Employee"
)

Did you ever work more than 40 hours in one week for RGIS?

What Position(s) did you work? (Answer Yes To All That Apply. A blank response = "No")

Auditor:

Assistant Team Leader:

Team Leader:

Associate Area Manager:

What is the last RGIS district you worked for? (If you don't remember select "Do Not Recall")