Background Check

Background Check

Address*

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Phone Type*

Have you ever been convicted of a crime?*

Typed signature above authorizes and requests any present or former employer, school, police department, financial institution, Division of Motor Vehicles or other person or agencies having personal knowledge about me to furnish bearer with any and all information in their possession regarding me, in connection with my childcare worker application. I give permission that a photocopy or electronic copy of this authorization be accepted with the same authority as the original.