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H Special Needs Criminal Background Check Unit Fax: 518-549-0464 Email: cbc JusticeCenter.ny.gov The purpose of this form is to designate an Authorized Person for your program who will be permitted to request, on behalf of your program, a check of the Staff Exclusion List (SEL). By signing this form, each signatory understands that all requests made by the Authorized Person for a check of the SEL by the Justice Center on each prospective employee, volunteer, consultant or resident in the home w.

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