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City of Conyers Police 1194 Scott Street S. E. Conyers GA 30012 Phone 770 602-2581 Fax 770 929-4245 www. CRIMINAL HISTORY CONSENT FORM I hereby authorize to receive any criminal history record information pertaining to me that may be in the criminal justice files of the State of Georgia or local criminal justice agency in the State of Georgia. Print Full Name Drivers License Number Street Address City/State/Zip Sex Race Date of Birth Social Security Number Special employment provisions...
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I hereby authorize to grant permission for a specific action or request.
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