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SAFETY PERFORMANCE HISTORY RECORDS REQUEST PART 1:TO BE COMPLETED BY PROSPECTIVE EMPLOYEES, (Print Name) First M.I. Last Social Security Number Hereby authorize: Date of Birth Previous Employer: Email:
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The form needs to be completed by anyone who is required or has been instructed to do so. This could include individuals applying for a job, filling out a government form, registering for a service, applying for a permit, or anyone else specified by the form's instructions.
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