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Required Package

The ADN Sophomore program at Northeast Iowa Community College requires the following services to be performed:

Background Check:Iowa Statewide Criminal Records (SING)
County Criminal Records (all jurisdictions outside of IA, 7 year history)
Nationwide Crime Database
Iowa Child and Dependent Adult Abuse Registry
Sexual Offender Registry
Healthcare Fraud & Abuse Registries
SSN / Address Validation
Drug Test:Oral fluid; Lab based 6 panel + oxy
After you place your order, please print your order confirmation and take it to your Department Administrator. Your Department Administrator will provide you with your Drug Testing Form. Your drug test collection will be performed in class.
Health Portal:This package includes document storage. At the end of the order process, you will have the capability to upload specific documents required by your school for immunization, medical or certification records.




 
 
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You are placing an order for

ADN Sophomore
CALMAR CAMPUS

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Upload Release Form
In order to obtain your Iowa Background Check and Child and Dependent Adult Abuse Registry search, it is required that *THESE RELEASE FORMS* is:

PRINTED (print this form off)

FILLED OUT (only fill the highlighted fields)

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.
* 2 pages must be provided. *

If both pages are not provided or filled out correctly, the Iowa portion of your background check will be cancelled and you will be required to place a new Iowa order at the cost of $5.00.

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


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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