OneSource Order Entry

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.

Total Check Plus

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!

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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)

MMDDYYYY -or- MM/DD/YYYY

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?

Include name, website, organization or any information regarding lead source.

Total Check PLUS 3.0

		County Criminal
		County Criminal - Statewide If Available