orders@onesourcebackground.com
E-Sign Act Disclosure
If you do not consent to proceed electronically contact One Source at 1.800.608.3645, and reference Client ID CWC3229. You may now exit this page.
NON LOCAL IMG ELEMENT FOUND - CONTACT SUPPORT
Central Wyoming College
Students
Please read all instructions before completing this form!
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.
Select NEXT to proceed to next screen.
Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.
Thank you!
SCRIPT ELEMENT REMOVED type="text/javascript" language="javascript">var ANS_customer_id="862d716d-a027-45b8-822c-8bf972ce8b47"; SCRIPT ELEMENT REMOVED type="text/javascript" language="javascript" src="//verify.authorize.net/anetseal/seal.js" >
Process Credit Cards
First Name
Enter full LEGAL first name. Do NOT enter nicknames or abbreviations.
Middle Name
Enter middle name or initial. Do NOT enter nicknames.
Last Name
Enter full legal last name. Do NOT enter nicknames or abbreviations.
Suffix
Enter suffix if applicable. EXAMPLE: Jr., Sr., III
AKA First Name
Enter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle Name
Enter middle name or initial. Do NOT enter nicknames.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle Name
Enter middle name or initial. Do NOT enter nicknames.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle Name
Enter middle name or initial. Do NOT enter nicknames.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle Name
Enter middle name or initial. Do NOT enter nicknames.
AKA Last Name
Enter aka or maiden name if applicable.
Street Address
Enter full street address.
City
State
Zip Code
Country Code
Please change if US is not the correct Country Code.
Prior Street Address
Enter complete Prior 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 complete Prior 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 complete Prior 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 complete Prior 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 complete Prior 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
For CA, MN, and OK residents, would you like a copy of the report emailed?
SSN
Enter social security number. Do not enter hyphens or dashes. EXAMPLE: 111223333
Birth Date (DOB)
MMDDYYYY -or- MM/DD/YYYY
Drivers License Number
Enter Drivers License Number.
Issuing State
Enter Drivers License Issuing State.
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 eSignature on release.
Total Check PLUS 3.0
County Criminal
County Criminal - Statewide If Available