UNIVERSITY OF NEBRASKA KEARNEY
Background Check #1
Please read all instructions before completing this form!
Enter the following data:
1. APPLICANT NAME: Enter First, Middle and Last Name. (Full Legal Name)
2. CURRENT ADDRESS: Enter complete Current Address.
3. SSN: Enter Social Security Number. Do not enter hyphens or dashes. EXAMPLE: 111223333
4. DOB: Enter Date of Birth. Do not enter hyphens or dashes. EXAMPLE: 12/10/1970 or 12101970
5. APPLICANT PHONE NUMBER: Enter a phone number the applicant can be reached at between 8 am and 5 pm.
6. APPLICANT EMAIL ADDRESS: Enter an email address the applicant can be reached at between 8am and 5pm.
7. DRIVERS LICENSE and ISSUING STATE: Enter an drivers license number and issuing state.
8. DEPARTMENT: Enter NU ID in this field.
After submitting your request, you will be presented with an invoice that will allow you to pay via credit or debit card. Payment will need to be received before we can complete the background check. If you do not have a credit card or debit card please contact One Source for alternative payment arrangements.
The fee for the services provided by One Source is $27.82 including Sales Tax, payment for which is made directly to One Source and accompanies this request.
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.
Individuals being considered for employment opportunities must self-disclose if they have been convicted of a felony, misdemeanor, or are subject to a restraining order. A conviction record is not an automatic disqualifier for employment. The University will determine the relevancy of the information provided to the position sought. Inaccurate, omitted, misrepresented, falsified, or incomplete statements on this disclosure may result in disqualification for employment or termination from employment for cause no matter when discovered.
Email One Source with any special notes/comments regarding this applicant at: firstname.lastname@example.org.
Select Next to proceed to next screen.
Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.