E-Sign Act Disclosure
If you do not consent to proceed electronically contact One Source at 1-800-608-3645, and reference Client ID SELFBASICMT. You may now exit this page.
Please read all instructions before completing this form!
The fee for the services provided by One Source is $15.00 including Nebraska 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.
Email One Source with any special notes/comments regarding this applicant at:
Select NEXT to proceed to next screen.
Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.
Process Credit Cards
Enter full legal first name.
Enter middle name or initial.
Enter full legal last name.
Enter complete current address.
Please change if US is not the correct country code.
For CA, MN, and OK residents, would you like a copy of the report emailed?
Enter social security number. Do not enter hyphens or dashes. EXAMPLE: 111223333
Birth Date (DOB)
MMDDYYYY -or- MM/DD/YYYY
Department would be provided by HR Department.
Enter a phone number that you can be reached at between 8am and 5pm.
Enter a valid e-mail address.
Basic Check 2.0
County Criminal - Statewide If Available