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Required Package

The Department of Teacher Education at University of Wisconsin-Eau Claire requires the following background check to be performed

Background Check:Wisconsin DOJ & DHFS Caregiver Background Check
Wisconsin Circuit Court Statewide Criminal Records
County Criminal Records (7 year history, all jurisdictions outside of Wisconsin)
Nationwide Crime Database
Nationwide Sexual Offender Registry
Healthcare Fraud & Abuse
Address History / SSN Validation
Price:$40.00




 
 
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Upload Release Form
In order to obtain Wisconsin background check information, it is required that *THIS FORM* be:

PRINTED (print this form off)

FILLED OUT (fill the form out completely)

UPLOAD (upload this form back onto site)

You cannot/will not be able to proceed with your order until this form has been completed and uploaded here.
*Both pages must be provided.*

Use this link to combine PDF files
OR
use this link to combine image files into a PDF file.


Please make sure that you have signed and dated ALL PAGES.

Applicant Information
First Name*:  
Last Name*:
Middle Name:
Alias/Maiden Name 1:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 2:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 3:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Social Security Number*:
-
-

Please Note: If you have not been issued a valid U.S. SSN then enter all zeros (000-00-0000) instead.
Date of Birth*:
/
/
(mm/dd/yyyy)
Gender*: Male        Female
Phone Number*: (111-111-1111)
E-Mail Address*:

Your email address will be your user name to log in. If you have placed a previous order, it is recommended to use the same email address to prevent separate logins. Separate logins will contain separate results / medical documents, and cannot be combined.
 
Type E-mail address.


Re-type E-mail address.

Please make sure you are entering your correct email address. You will be unable to log in or receive communications from Viewpoint Screening if your email address is not valid.
 
Current Residential Address
Address*:
City*:
State or U.S. Territory*:

For an international address, select "International" and select the foreign Country name below.
Country*:
Zip Code*:
ZIP Code Look Up Tool
Please Note: If you have an international address that does not require a Zip Code, please fill in "00000".
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