Transcription of Safety Performance History Records Request
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Safety Performance History Records Request
Safety Performance History Records Request PART 1: TO BE COMPLETED BY PROSPECTIVE EMPLOYEE I, (Print Name) _____ _____ First Last Social Security Number Hereby authorize: _____ Date of Birth Previous Employer: _____ Email: _____ Street: _____ Telephone: _____ City, State, Zip: _____ Fax No.
preceding three years. I understand, for records requested from a prospective employer, that I must arrange to pick up or receive the requested records within thirty (30) days of the records being made available or I have waived my request to review the records. This information should be: sent to me at the above address.
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