E-Sign Act Disclosure
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Department of Education

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After submitting your request, you will be presented with an invoice that will allow you to pay via credit or debit card. Payment will need to be received before we can complete the background check. If you do not have a credit card or debit card please contact One Source for alternative payment arrangements.

The fee for the services provided by One Source is $38.70 including 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.

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First NameEnter full legal first name.
Middle NameEnter middle name or initial.
Last NameEnter full legal last name.
SuffixEnter suffix if applicable. EXAMPLE: Jr., Sr., III
AKA First NameEnter aka first name. Do not enter Nick Names such as Rob for Robert.
AKA Middle NameEnter aka middle name or initial.
AKA Last NameEnter aka or maiden name if applicable.
Street AddressFull Street Address
Zip Code Zip Code Notes
Country Code Please change if US is not the correct Country Code
Prior Street AddressEnter prior full address.
Prior City
Prior State
Prior Zip Code
Prior Country CodePlease change if US is not the correct Country Code
Request Copy ?Would you like a copy of the report ?
SSNEnter social security number. Do not enter hyphens or dashes. EXAMPLE: 11122333
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 e signature on release
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