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Total Check Plus


Central Community College
Health Sciences-Drug Test 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.
Please note, this payment is in addition to the payment you provided for the background check. Your drug test results will NOT be released until payment has been received.
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.

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!

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
 
Street AddressEnter your full street address
City
State
Zip Code
Country Code Please change if US is not the correct country 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
 
 
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