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E-Sign Act Disclosure
If you do not consent to proceed electronically contact One Source at 1-800-608-3645, and reference Client ID MIDUNI2913. You may now exit this page.




Total Check


Midland University Students

Please read all instructions before completing this form!

The fee for the services provided by One Source is $37.45 including Nebraska 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.

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!

Process Credit Cards
 
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
 
AKA First NameEnter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle NameEnter middle name or initial. Do NOT enter nicknames.
AKA Last NameEnter aka or maiden name if applicable.
 
AKA First NameEnter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle NameEnter middle name or initial. Do NOT enter nicknames.
AKA Last NameEnter aka or maiden name if applicable.
 
AKA First NameEnter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle NameEnter middle name or initial. Do NOT enter nicknames.
AKA Last NameEnter aka or maiden name if applicable.
 
AKA First NameEnter full AKA first name. Do NOT enter nicknames or abbreviations.
AKA Middle NameEnter middle name or initial. Do NOT enter nicknames.
AKA Last NameEnter aka or maiden name if applicable.
 
Street AddressEnter full street address.
City
State
Zip Code
Country Code Please change if US is not the correct Country Code.
 
Prior Street AddressEnter complete Prior Address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease change if US is not the correct Country Code.
 
Prior Street AddressEnter complete Prior Address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease change if US is not the correct Country Code.
 
Prior Street AddressEnter complete Prior Address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease change if US is not the correct Country Code.
 
Prior Street AddressEnter complete Prior Address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease change if US is not the correct Country Code.
 
Prior Street AddressEnter complete Prior Address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease 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
Birth Date (DOB)Enter date of birth. Do not enter hyphens or dashes. EXAMPLE: 12101970
Drivers License NumberEnter Drivers License Number.
Issuing StateEnter Drivers License Issuing State.
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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