1
Required Package

Northeast Wisconsin Technical College requires the following service(s) to be performed by Viewpoint Screening:

Background Check:Wisconsin DOJ & DHFS Caregiver Background Check
Wisconsin Circuit Court Statewide Criminal Records
Price:$25.00


I have read, understand and agree to the Viewpoint Screening Terms of Use and Refund Policy .

You are placing an order for

Physical Therapist Assistant

Click "Confirm" to continue.

If this is not the correct program, go back to the previous page and select the correct package.

Confirm
Upload Release Form
To obtain Wisconsin background check information, it is required that *this form* be:

FILLED OUT (fill the form out completely, including your initials)

SAVED TO YOUR COMPUTER

UPLOADED (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*
If the 2 pages are not provided or filled out correctly, your Wisconsin background check will be cancelled and you will be required to place a new Wisconsin order at the cost of $5.00.

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 this document.
 
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*:

IMPORTANT
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 your email 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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