E-Sign Act Disclosure
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Total Check


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The fee for the services provided by One Source is $39.00, plus Nebraska Sales Tax. Additional names and/or locations will be $10.00 each and court fees may apply. Payment 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: orders@onesourcebackground.com.

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Questions? Contact One Source at 402.933.9999 or 1.800.608.3645.
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First NameEnter full legal first name.
Middle NameEnter middle name or initial.
Last NameEnter full legal last name.
AKA First NameEnter aka first name. Do NOT enter nicknames.
AKA Middle Name
AKA Last NameEnter aka last name. Do NOT enter nicknames.
Street AddressEnter complete current address.
Zip Code
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
Request Copy?For CA, MN, and OK residents, would you like a copy of the report emailed?
SSNEnter social security number. Do not enter hyphens or dashes. EXAMPLE: 111223333
DepartmentDepartment would be provided by HR Department.
Phone NumberEnter a phone number that you can be reached at between 8am and 5pm.
Email AddressEnter a valid e-mail address.
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