CRIMINAL HISTORY CHECK RELEASE FORM

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					                              CRIMINAL HISTORY/DRIVING RECORD
                                       RELEASE FORM



North Central Texas College may conduct a criminal history record on prospective employees. Please TYPE or PRINT the
information requested below and sign the release form.


*NAME:___________________________________________________________________________
                    Last                                   First                                      Middle

Current Address            Street_________________________ Apartment # ____________________
                           City _________________________ State__________ Zip ____________
*Driver’s License # _______________________________                   State __________       Exp Date ________

* Date of Birth ___________________________________ *Social Security # ________________

I hereby authorize North Central Texas College to conduct a criminal history check.


___________________________________                                      ______________________________
Signature                                                                                   Date

Requested By _____________________


Criminal History Results                                                  Driving Record Results
Date      ________                                                        Date     _________
Initials    ________                                                       Initials   _________




                                                                                                                       2003

				
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