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Total Check Plus


Central Community College
Health Sciences-Background Check Only



Please read all instructions before completing this form!



The fee for the services provided by One Source is $25.00, payment for which is made directly to One Source and accompanies this request.

Once you submit your One Source background check, you will receive a supplemental email directly from DHHS.CFSCR@nebraska.gov to complete your Nebraska Adult and Child Abuse registry check. If you do not receive your link within 24 hours of submitting your background check contact One Source at 800.608.3645 and choose Option 1 to request the link be sent. Your background check is NOT complete until the NE DHHS portion is done.


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!

Process Credit Cards
 
First NameEnter your legal first name
Middle NameEnter your middle name or initial. Leave blank if there is no middle name
Last NameEnter your legal last name
Suffix
 
AKA First NameEnter previous first name. Do NOT enter nicknames
AKA Middle Name
AKA Last NameEnter previous last name. Do NOT enter nicknames
 
AKA First NameEnter previous first name. Do NOT enter nicknames
AKA Middle Name
AKA Last NameEnter previous last name. Do NOT enter nicknames
 
AKA First NameEnter previous first name. Do NOT enter nicknames
AKA Middle Name
AKA Last NameEnter previous last name. Do NOT enter nicknames
 
AKA First NameEnter previous first name. Do NOT enter nicknames
AKA Middle Name
AKA Last NameEnter previous last name. Do NOT enter nicknames
 
Street AddressEnter your full street address
City
State
Zip Code
Country Code Please change if US is not the correct country code
 
Prior Street AddressEnter previous address
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter previous address
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter previous address
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter previous address
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter previous address
Prior City
Prior State
Prior Zip Code
 
Request Copy?Select yes if you would like a copy of your report emailed to you
SSNEnter your Social Security Number in 999999999 format
Birth Date (DOB)MMDDYYYY -or- MM/DD/YYYY
Student CCC ID#Entered by your Student CCC ID#
Phone NumberEnter a phone number that you can be reached at between 8am and 5pm
Email AddressEnter your email address
 
 
  Total Check PLUS 3.0
  County Criminal
  County Criminal - Statewide If Available  EScreen-10Panel-1204
  National Practitioner Data Bank  NE Adult Abuse Registry 1.0
  NE Child Abuse Registry 1.0  OIG - SAM
  Wants And Warrants