orders@onesourcebackground.com
 

UNMC HEALTH SCIENCES PROGRAM
College of Dentistry-Re-Screen



THIS ACCOUNT IS FOR RE-SCREENING PURPOSES ONLY. DO NOT ENTER INFORMATION UNLESS YOU HAVE PREVIOUSLY COMPLETED AN INITIAL BACKGROUND CHECK WITH ONESOURCE


Please read all instructions before completing this form!

Please contact One Source at 800.608.3645 if additional assistance is needed.

Enter the following data:
1. APPLICANT NAME: Enter First, Middle and Last Name. (Full Legal Name)
2. CURRENT ADDRESS: Enter complete Current Address.
3. SSN: Enter Social Security Number. Do not enter hyphens or dashes. EXAMPLE: 111223333
4. DOB: Enter Date of Birth. Do not enter hyphens or dashes. EXAMPLE: 12/10/1970 or 12101970
5. APPLICANT PHONE NUMBER: Enter a phone number the applicant can be reached at between 8 am and 5 pm.
6. APPLICANT EMAIL ADDRESS: Enter an email address the applicant can be reached at between 8am and 5pm.
7. DRIVERS LICENSE and ISSUING STATE: Enter a drivers license number and issuing state.
8. DEPARTMENT: Do not enter information in this field.

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 $21.45 including Sales Tax, payment for which is made directly to One Source and accompanies this request.

Once you submit your One Source background check, you will receive a supplemental email directly from DHHS.CFSCR@nebraska.gov to complete your Nebraska Adult and Child Abuse registry check.

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 NameEnter full legal first name.
Middle NameEnter middle name or initial.
Last NameEnter full legal last name.
Suffix
 
AKA First NameEnter aka first name. Do NOT enter nicknames.
AKA Middle Name
AKA Last NameEnter aka last name. Do NOT enter nicknames.
 
AKA First NameEnter aka first name. Do NOT enter nicknames.
AKA Middle Name
AKA Last NameEnter aka last name. Do NOT enter nicknames.
 
AKA First NameEnter aka first name. Do NOT enter nicknames.
AKA Middle Name
AKA Last NameEnter aka last name. Do NOT enter nicknames.
 
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.
City
State
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
 
Prior Street AddressEnter prior full address.
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter prior full address.
Prior City
Prior State
Prior Zip Code
 
Prior Street AddressEnter prior full address.
Prior City
Prior State
Prior Zip 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
Birth Date (DOB)MMDDYYYY -or- MM/DD/YYYY
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 phone number that you can be reached at between 8am and 5pm.
 
 
  Total Check v3.0
  County Criminal
  County Criminal - Statewide If Available  NE Adult Abuse Registry 1.0
  NE Child Abuse Registry 1.0  OIG - SAM