Request for Local Law Enforcement

Check for Applicants/Employer

Re: Local Law Enforcement Check

Pursuant to Chapter 85-54, Laws of Florida, Life's New Beginnings, Inc., requests a local records check on the applicant listed below:

_____________________________	______________________	___________________________

Last Name	First Name	Middle Name

___________________	__________________	_______________	_________

Date of Birth	Social Security Number	Race	Sex

Please document the findings on this check and return the information to the applicant or send to:

Life's New Beginnings

7031 Rockwood Drive

Port Richey, Fl. 34668

727-312–3108 Fax: 727-312-3229

amym0255@gmail.com

__________________________________

Appointing Authority Signature

I hereby authorize _________________________________ Sheriff Dept to check any and all records pertaining to criminal convictions, and for any law enforcement agency to release to Life's New Beginnings information regarding convictions under Florida Statutes or statutes of other jurisdictions.

______________________	__________________________________

Date	Applicant for Employment

(Please include a self addressed and stamped envelope with this local law enforcement check for return of findings to Life's New Beginnings. Use the address or email address above.)