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Please complete the following form regarding a national background check. Do we have your permission to conduct a national background check for each year that you volunteer in the program? Please initial: Yes___ NO___This form is required for all criminal background searches.___|___Last Name_ City_ |___Middle Name___ Street Address|___First NameStateHome Phone Number|___|___/___/___ ZipSocial Security #Date of BirthPLEASE READ THE FOLLOWING STATEMENT AND INDICATE YOUR
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