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Required Package

The Division of Communication Disorders at University of Wyoming requires the following background check to be performed.

Background Check:County Criminal Records (7 year history, all jurisdictions)
Nationwide Sexual Offender Registry
Healthcare Fraud & Abuse (OIG/GSA)
US Patriot Act / OFAC
Social Security Validation
Price:$47.50
Verification:Employment*
Price:$41.95
Release Form:You are required to print and fill out this Release Form. You must fax this form to Viewpoint Screening at 888-516-2444.
Attention:*Employers and institutions charge a service fee for employment verifications.

This fee has been included within your background check package price.
Total Price:$89.45


 
  I have read, understand and agree to the Viewpoint Screening Disclaimer.
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.
 
Type E-mail address.


Re-type E-mail address.
 
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".
 
Employment History:
Check this box if you do not have an employer to be verified
Company Name:
City:
State:
Phone:
Position:
Salary:
Employment Dates: From  /  to  /
Reason for Leaving:
 
Employment History 2:
Company Name:
City:
State:
Phone:
Position:
Salary:
Employment Dates: From  /  to  /
Reason for Leaving:
 
Employment History 3:
Company Name:
City:
State:
Phone:
Position:
Salary:
Employment Dates: From  /  to  /
Reason for Leaving:
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