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Rock Island County Regional Office of Education 3430 Avenue of the Cities Molina, IL 61265 309.736.1111 309.736.1127 (Fax) Fee Applicant Consent Release Please Print Clearly Last Name First Name MI
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Provide your contact information, including your address, phone number, and email address.
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If applicable, enter your social security number or any other identification number requested.
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Next, indicate the purpose for which you are submitting the form, such as a job application or license renewal.
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Review the consent and release statements included in the form. Ensure that you understand and agree to the terms outlined.
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Sign and date the form at the appropriate location to acknowledge your consent and release of your fingerprint information.
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It is a form used for applicants to consent to fingerprinting and background checks.
Applicants for certain roles or licenses may be required to file this form.
Applicants must provide personal information and sign the consent section on the form.
The purpose is to authorize a background check for the applicant.
Personal information, consent for fingerprinting, and authorization for background checks.
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