Background Consent/ Release Form
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What's your first name? *

 
Hi {{answer_33917965}}. What's your last name?

 
Social Security Number

 
Date of Birth

 
Driver's License Number

 
Applicant's Address

 
AUTHORIZATION *

I authorize and give consent for the City of Monte Vista to obtain information regarding myself. This includes the following:
             Criminal background records/information
             Sex Offender Registry Check
             Addresses
I the undersigned, authorize this information to be obtained either in writing or via telephone in connection with my application. Any person, firm, or organization providing informationor records in accordance with this authorization isI the undersigned, authorized this information to be obtained either in writing or via telephone in connection with my application. Any person, firm, or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization’s guidelines.
     
 
Date signed

 
Applicant Signature

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