AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. TCIC/NCIC/Police/Sheriff’s Records Signature Date El Paso County Juvenile Probation Department TCIC/NCIC CONTRACTOR RECORDS CHECK REQUEST REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.
Appears in 5 contracts
Samples: Crisis Intervention Services, Interlocal Agreement, www.epcounty.com
AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. XXXX XXXXXXXXX XXXXX XXXXXXXX JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. TCIC/NCIC/Police/Sheriff’s Records Signature Date El Paso County Juvenile Probation Department TCIC/NCIC CONTRACTOR RECORDS CHECK REQUEST REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.
Appears in 3 contracts
Samples: Intensive Outpatient Drug Treatment Services, Home Services, www.epcounty.com
AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. TCIC/NCIC/Police/Sheriff’s Records Signature Date El Paso County Juvenile Probation Department TCIC/NCIC CONTRACTOR RECORDS CHECK REQUEST REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.SSN
Appears in 1 contract
Samples: Agreement
