Elkhorn Athletic Association
Volunteer Background Check Form
Please read all instructions before completing this form!
Enter the following data:
Enter First, Middle and Last Name. (Full Legal Name)
Enter complete Current Address.
Enter Social Security Number. Do not enter hyphens or dashes. EXAMPLE: 111223333
Enter Date of Birth. Do not enter hyphens or dashes. EXAMPLE: 12/10/1970 or 12101970
APPLICANT PHONE NUMBER:
Enter a phone number the applicant can be reached at between 8 am and 5 pm.
APPLICANT EMAIL ADDRESS:
Enter an email address the applicant can be reached at between 8am and 5pm.
DRIVERS LICENSE and ISSUING STATE:
Enter a drivers license number and issuing state.
Do not enter information in this field.
The following information may be required by law enforcement agencies, local, state or federal governmental agencies or similar public bodies for positive identification purposes when checking public records. I understand that this information is confidential and will only be used for background screening purposes.
According to the Fair Credit Reporting Act you are to be provided with a copy of your rights according to the FCRA. Please click here for the
Summary of Consumer Rights According to the FCRA.
Email One Source with any special notes/comments regarding this applicant at:
Select Next to proceed to next screen.
Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.
Your Email Address
Daytime Phone Number
Full Street Address
Social Security Number
Birth Date (DOB)
MMDDYYYY -or- M/D/YYYY
Driver's License #
For California, Minnesota, and Oklahoma residents only, would you like a copy of the report sent to you?
Total Check v3.0 ( County Criminal - Statewide If Available, Federal Criminal, Global Watch, National Sex Offender Registry, Nationwide Alert, Social Security Trace, )
County Criminal - Statewide If Available