E-Sign Act Disclosure
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The fee for the services provided by One Source is $16.00, 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.

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First NameEnter full LEGAL first name. Do NOT enter nicknames or abbreviations.
Middle NameEnter middle name or initial. Do NOT enter nicknames.
Last NameEnter full legal last name. Do NOT enter nicknames or abbreviations.
SuffixEnter suffix if applicable. EXAMPLE: Jr., Sr., III
Street AddressEnter full street address.
Zip Code
Country Code Please change if US is not the correct Country Code.
Request Copy ?For CA, MN, and OK residents, would you like a copy of the report emailed?
SSNEnter social security number. Do not enter hyphens or dashes. EXAMPLE: 111223333
Drivers License NumberEnter Drivers License Number.
Issuing StateEnter Drivers License Issuing State.
Expected Salary
DepartmentDepartment would be provided by HR Department.
RecruiterRecruiter would be provided by HR Department.
Position Applied For
Phone NumberEnter a phone number the applicant can be reached at between 8 am and 5 pm.
Email AddressEnter an email address. REQUIRED for eSignature on release.
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