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 PLUSSELFCHECK. You may now exit this page.
Self-Check
TotalCheck PLUS
Please read all instructions before completing this form!
The fee for the services provided by One Source is $89.00, plus Nebraska Sales Tax.
Please note, One Source will not search New York addresses.
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.
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 Name
Enter full legal first name.
Middle Name
Enter middle name or initial.
Last Name
Enter full legal last name.
Suffix
Enter suffix if applicable. EXAMPLE: Jr., Sr., III
AKA First Name
Enter aka first name. Do not enter nicknames such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
AKA First Name
Enter aka first name. Do not enter nicknames such as Rob for Robert.
AKA Middle Name
Enter aka middle name or initial.
AKA Last Name
Enter aka or maiden name if applicable.
Street Address
Full Street Address
City
State
Zip Code
Zip Code Notes
Country Code
Please change if US is not the correct Country Code
Prior Street Address
Enter prior full 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 prior full address.
Prior City
Prior State
Prior Zip Code
Prior Country Code
Please change if US is not the correct Country Code
SSN
Enter social security number. Do not enter hyphens or dashes. EXAMPLE: 11122333
Birth Date (DOB)
Enter date of birth. Do not enter hyphens or dashes. EXAMPLE: 12101970
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 e signature on release
Did any indidvidual direct you to One Source for screening?
YES
NO
Include name, website, organization or any information regarding lead source.
Total Check PLUS 3.0
County Criminal
County Criminal - Statewide If Available