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Get Ga Apd 928 - City Of Atlanta 2018-2024

Of any State or Local Criminal Justice agency. This authorization is valid for 90 days from date of signature. / DOB: (Last) (First) (Middle) Race Sex Month / Date Year (Date of Birth) / / Address / Social Security Number (If applicable, maiden name, or name used in the past) / City / / State Zip Code Telephone # Date Signature Notary Expiration Date Please check one of following for type of employment: Employment with mentally disabled Employment with elder care Em.

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