11/15/2021
I hereby authorize Newpoint Partnership Inc to have a records search performed and to receive any criminal history record information pertaining to me which may be in the files of any federal, state or local criminal justice agency.
Full Name: (Please Print) _______________________________________________________
Complete Address: _______________________________________________________
_______________________________________________________
_______________________________________________________
Sex: □ Male □ Female
Date of Birth: _________________________
City/State of Birth: _________________________
Race: _________________________
Social Security Number: _________________________
This authorization is valid for 90 days from date of signature.
Signature: ______________________________________________ Date: _________________