Volunteer Background Check

Volunteer Background Check Consent Form

Non-Profit Account # T189271383

Date

The following named individual has made application with this agency for:

Reason

First Name

M Name

Last Name

Current Address

Height

Weight

Eye Color

Hair Color

State of Birth

SSN

Drivers

Expiration Date

Have you lived outside of Minnesota in the last 5 Years?

Outside MN

State List

I authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to Aitkin County CARE, Inc. for the purpose of with this agency. The expiration of this authorization shall be one year from the date of my signature.

Sign

Volunteer Background Check

Volunteer Background Check Consent Form Non-Profit Account # T189271383

Volunteer Background Check Consent Form

Non-Profit Account # T189271383