Free background check form 32
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EAU CLAIRE COUNTY SHERIFF’S OFFICE
BACKGROUND CHECK AUTHORIZATION
NAME OF PERSON MAKING THE REQUEST (PLEASE PRINT):

(FIRST)

(MIDDLE)

Telephone Numbers: (Home):

(LAST)

(Cell):

(Other):

Driver’s License Number:

State:

Email Address:

NAME OF PERSON YOU WANT A BACKGROUND ON (PLEASE PRINT):

(FIRST)

(MIDDLE)

(LAST)

Date of Birth:
Former Name(s) Used:
Current Address Since:
(Mo/Yr)

(Street)

(City)

(State/Zip)

(Mo/Yr)

(Street)

(City)

(State/Zip)

Previous Address Since:

_

Telephone Numbers: (Home):

(Cell):

(Other):

Driver’s License Number:

State:

The information contained in this application is correct to the best of my knowledge. I hereby authorize Eau Claire County
Sheriff’s Office and its designated agents and representatives to conduct a comprehensive review of my background.
I further authorize Eau Claire County Sheriff’s Office to divulge any, and all information, verbal or written pertaining to me to
or its agents. I further authorize the complete release of