Subject's Lie Detector Test Case Information (2021)

Subject's Lie Detector Test Case Information (2021)
This form is STEP 2 in the polygraph exam process. Do not complete this form until you have a confirmed appointment date.

This form is for the Subject taking the exam to complete ONLY. This form may not be completed by anyone else other than the person taking the polygraph exam.

This form is compromised of 11 different sections, A-J.

A: Exam Verification

B: Subject's Information

C: Accuser's Information

D: Disclaimers

E: Statement Collection

F: Question Submission

G: Evidence Collection (Option to Upload Files)

H: Credibility Assesment

I: Policies & Notices

J: Signature & Form Submission

Depending upon your responses, this form may take anywhere from 20 minutes to 45 minutes to complete.

Section A: Verify Your Exam(s) is Already Scheduled
SECTION A: VERIFY YOUR EXAM

Before completing this form, you should have already scheduled and paid for your exam online during Step 1. Please verify your exam information below.
What is the confirmed date of your scheduled polygraph and/or EyeDetect exam? *

Month Day Year
This was the date you selected in Step 1 when you booked and paid for your exam online.
What is the time of your polygraph and/or EyeDetect exam?

: Hour Minutes AM/PM Option
What type of exam(s) have you scheduled? *
This is the service you paid for when you scheduled your exam online during Step 1.
Are you the person taking the exam?

Yes No

Section B: SUBJECT'S INFORMATION
SECTION B: THE SUBJECT'S INFORMATION

The Subject is the person taking the polygraph or EyeDetect exam.
Subject's Full Legal Name *
The Subject is the person taking the exam.
What name do you, the Subject, go by (Nickname/street name) ? *
The Subject is the person taking the exam.
Address
Subject's Primary E-mail address *
Alternative Emails: List any other email addresses you have to include any hidden, undisclosed, secret, sudo, fake or alias email accounts you have: *
Subject's Phone Number *
Alternative Phone Numbers: List any other phone numbers to include any hidden, undisclosed, secret or alias phone numbers you have to include any burner phones, VOIP, Aps or Digital only numbers. *
List any privacy-based Aps, tools or technologies you use? (Example: Private Mode, VPN, VPS, Signal, MySudo, TOR, FreeNet, etc...) *
List ALL social media accounts you have to include any secret, hidden, undisclosed, fake, sudo or alias accounts along with your Screen Name and the platform:
Subject's Date of Birth *

Month Day Year
The Subject must be at least 16 years of age.
What is your relationship to the Accuser/Victim? *
In other words, who are you?
Do you, the Subject, have any medical or mental health conditions that could prevent you from safely and successfully taking a polygraph and/or EyeDetect exam? *

No Yes (Explain in the box below)
If you answered YES, please explain in detail in the box below.
Do you, the Subject, take any medications that could effect the exam? *

No Yes (Explain in the box below)
If you answered YES, please explain in detail in the box below.
Have you ever been arrested or convicted of a crime? If yes, please explain each arrest and charges in the space below. *

No Yes (Explain in the box below)
If you answered YES, please explain in detail in the box below.
Do you, the Subject, understand that you are prohibited from drinking any alcohol or using any recreational drugs for a minimum of 24 hours prior to your exam? *

Yes No
Take Photo: To verify that you, the Subject, are the person filling out this form, please take of yourself. *

Section C: ACCUSER / VICTIM'S INFORMATION
SECTION C: THE ACCUSER/VICTIM'S INFORMATION

The Accuser or Victim is the person making the allegation against the Subject.
Accuser/Victim's Full Legal Name *
What is the Accuser/Victim's relationship to the Subject? *
In other words, who is the Accuser/Victim?
Accuser/Victim's Phone Number *
Accuser/Victim's Email *
example@example.com
Is the Accuser/Victim a minor? *

Yes No

Section D: Lie Detector Test Notice and Disclaimer
SECTION D: NOTICE AND DISCLAIMER
Read the statement below and then check the button to acknowledge that you read, understand, accept and consent to the following statement in regards to taking a lie detector test. *

I understand that all polygraph and/or EyeDetect exams conducted by Validate, LLC will cover ONE and ONLY ONE Single, Specific Issue per exam. I understand that all relevant questions asked on any exam by Validate, LLC will be directly related to the ONE Single, Specific issue being tested. I understand that the polygraph examiner and/or EyeDetect proctor will formulate, write and solely determine the specific questions that will be asked on any exam. I understand that 2 to 4 relevant questions may be asked on the polygraph exam. I understand that only 1 relevant question, which will be asked in a variety of different ways, will be asked on the EyeDetect exam. I understand that if I have multiple issues and/or more questions than is already included that I would need to purchase additional services for an additional fee. I understand that polygraph exams and EyeDetect exams may only test facts and specific actions. I understand that polygraph exams and EyeDetect exams may not test feelings, thoughts, emotions, fantasies, desires, wants or future intentions. I understand that all questions on a polygraph exam will be in a yes or no only format. I understand that all questions on the EyeDetect will be in a true or false only format. I understand that Polygraph exams and EyeDetect exams are not 100% accurate and have a variable margin of error. I understand that the Subject takes the examination at his/her own risk and of his/her own free will. I understand, consent and agree to hold harmless and release all liability of any kind against Validate, LLC or its members.

Section E: Statement Collection
SECTION E: STATEMENT COLLECTION
In the space below, tell us the entire story, from beginning to end, without omitting or withholding any details, as to what happen that is causing you to take a lie detector test. There is no text limit. Type as much information as needed to tell the complete story. This statement serves as your voice and point of view so ensure you provide as much detail as possible. *
Do not include questions in your statement. You will have the opportunity to provide questions later in this form.

Section F: Question Selection
SECTION F: SELECT THE QUESTION YOU WANT ASKED ON YOUR EXAM
SECTION F: SELECT THE ONE (1) QUESTION YOU WANT TESTED ON THE EXAM BASED OFF YOUR RELATIONSHIP STATUS AND/OR THE ISSUE BEING TESTED.
SELECT ONE TEST:

MARRIED - INFIDELITY TEST WHERE THE SUBJECT HAS A COMPLETE & TOTAL DENIAL OF CHEATING OF ANY KIND - This test examines if the Subject had any type of sexual contact with anyone other than their HUSBAND/WIFE since being MARRIED TO PRESENT? (Ideal for couple's where the Subject has denied any and all acts of cheating ever.) MARRIED - INFIDELITY TEST WHERE THE SUBJECT HAS ADMITTED TO SELECTIVE CHEATING BUT DENIES DOING ANYTHING ELSE: This test examines if the Subject had any type of UNDISCLOSED sexual contact with anyone other than their HUSBAND/WIFE since being MARRIED TO PRESENT? The test is ideal for couple's where the Subject has disclosed information about limited acts of sexual contact but denies any other other acts of cheating. Example: Admits to cheating one time with one person only but denies ever doing anything else.) This exam tests if there anything or anyone else that is undisclosed, is still being hidden or omitted. DATING - INFIDELITY TEST WHERE THE SUBJECT HAS A COMPLETE & TOTAL DENIAL OF CHEATING OF ANY KIND - This test examines if the Subject had any type of sexual contact with anyone other than their BOYFRIEND/GIRLFRIEND since being IN A COMMITTED EXCLUSIVE RELATIONSHIP TO PRESENT? The Subject(Ideal for couple's where the Subject has denied any and all acts of cheating ever.) DATING - INFIDELITY TEST WHERE THE SUBJECT HAS ADMITTED TO SELECTIVE CHEATING BUT DENIES DOING ANYTHING ELSE. This test examines if the Subject had any type of UNDISCLOSED sexual contact with anyone other than their BOYFRIEND/GIRLFRIEND since being IN A COMMITTED EXCLUSIVE RELATIONSHIP TO PRESENT? The test is ideal for couple's where the Subject has disclosed information about limited acts of sexual contact but denies any other other acts of cheating. Example: Admits to cheating one time with one person only but denies ever doing anything else.) This exam tests if there anything or anyone else that is undisclosed, is still being hidden or omitted. FULL DISCLOSURE STATEMENT VALIDATION - This exam is exclusively done to validate the written, full disclosure statement as directed by a therapist. SEXUAL CONTACT WITH A MINOR - Has the Subject had any type of sexual contact with a minor since the Subject has been an Adult. CUSTOM POLYGRAPH ONLY EXAM: In the space below, please provide one (1) very specific question about the one specific issue you are coming in to be tested about. There will be 1-4 relevant questions asked on the polygraph exam formulated by the examiner based off the information provided. CUSTOM EyeDetect ONLY EXAM: In the space below, please provide one (1) very specific question about the one specific issue you want answered on the EyeDetect. IMPORTANT: IT TAKES A MINIMUM OF 3-5 BUSINESS DAYS AFTER RECEIVING ALL CASE INFORMATION FROM ALL PARTIES TO WRITE A CUSTOM EYEDETECT EXAM. YOUR APPOINTMENT MAY BE RESCHEDULED TO ALLOW FOR THE TIME REQUIRED TO WRITE A CUSTOM EYEDETECT EXAM. CUSTOM POLYGRAPH AND EyeDetect EXAMS: In the space below, please provide one (1) very specific question about the one specific issue you are coming in to be tested about. IMPORTANT: IT TAKES A MINIMUM OF 3-5 BUSINESS DAYS AFTER RECEIVING ALL CASE INFORMATION FROM ALL PARTIES TO WRITE A CUSTOM EYEDETECT EXAM. YOUR APPOINTMENT MAY BE RESCHEDULED TO ALLOW FOR THE TIME REQUIRED TO WRITE A CUSTOM EYEDETECT EXAM. There will be 1-4 relevant questions asked on the polygraph exam formulated by the examiner based off the information provided and 1 question asked on the EyeDetect formulated by Converus.
CUSTOM EXAMS ONLY: In the space below, type one, single, simple and direct question only. Do NOT write a compound, complex, run-on or multi-part question.

Section G: Evidence Collection
SECTION G: EVIDENCE COLLECTION
Is there any evidence to support the accusations being made against you, the Subject? If yes, please describe the evidence in detail in the box below. You can also upload copies of any files, photos or other digital evidence you may have below.
Upload a copy of any files, photos or other digital evidence you want to share:

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Section J: Sign & Submit
SECTION J: CONFIRM, SIGN AND SUBMIT
I, the Subject, hereby confirm under any applicable laws, that the statements made by me within this form are the truth, the whole truth and nothing but the truth.
Signature *

Clear
Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Should be Empty: