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I give consent to the above-named entity to perform periodic criminal history background checks for the duration of my employment. Signature Date Notary Public Signature My commission expires Date of Inquiry Contact Email address Time of Inquiry Operator s Initials Purpose Code Used check all that apply E - Employment J - Civilian Criminal Justice Employment State III Info Received M - Working with Mentally Disabled N - Working with Elderly P - Public Records U - Personal Copy W - Working...
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