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Central Community College Early Childhood Education Department
Please read all instructions before completing this form!
Central Community College requires all ECED students to complete a background check prior to starting their practicums.
Please complete the criminal background check through One Source by entering your information below. The fee for the services provided by One Source is $33.70 including Nebraska Sales Tax, payment for which is made directly to One Source and accompanies this request.
You may accrue additional charges if you have lived outside the United States in the past 7 years and need to have an international criminal search completed.
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.
California applicants only, Click
here
to view the California Law Notice
New Jersey applicants only, Click
here
to view the New Jersey Law Notice
New York applicants only, Click
here
to view the New York Correction Law Article
Washington applicants only, Click
here
to view the Washington State Summary of Rights
Email One Source with any special notes/comments regarding this applicant at:
orders@onesourcebackground.com.
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Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.
Thank you!
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Process Credit Cards
First Name
Enter full legal first name.
Middle Name
Enter middle name or initial.
Last Name
Enter full legal last name.
Suffix
Enter suffix if applicable. EXAMPLE: Jr., Sr., III
AKA First Name
Enter aka first name. Do not enter Nick Names such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter aka first name. Do not enter Nick Names such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter aka first name. Do not enter Nick Names such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter aka first name. Do not enter Nick Names such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
Street Address
Full Street Address
City
State
Zip Code
Zip Code Notes
Country Code
Please change if US is not the correct Country Code
Prior Street Address
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Prior City
Prior State
Prior Zip Code
Prior Country Code
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Prior Street Address
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Prior City
Prior State
Prior Zip Code
Prior Country Code
Please change if US is not the correct Country Code
Prior Street Address
Enter prior full address.
Prior City
Prior State
Prior Zip Code
Prior Country Code
Please change if US is not the correct Country Code
Prior Street Address
Enter prior full address.
Prior City
Prior State
Prior Zip Code
Prior Country Code
Please change if US is not the correct Country Code
Prior Street Address
Enter prior full address.
Prior City
Prior State
Prior Zip Code
Prior Country Code
Please change if US is not the correct Country Code
Request Copy ?
NO
YES
Would you like a copy of the report ?
SSN
Enter social security number. Do not enter hyphens or dashes. EXAMPLE: 11122333
Birth Date (DOB)
MMDDYYYY -or- MM/DD/YYYY
Phone Number
Enter a phone number the applicant can be reached at between 8 am and 5 pm.
Email Address
Enter an email address. REQUIRED for e signature on release
Total Check PLUS 3.0
County Criminal
County Criminal - Statewide If Available
International Criminal Search