Criminal Records Release Form

Complete the following release and Fax to the Staftrack Data Center
at 727-581-3725 or E-mail scanned image to

I hereby authorize Staftrack, Inc. to act as my agent for the purpose of receiving this criminal
history record information pertaining to me which may be in the files of any state or local
criminal justice agency.
Full Name (printed)                                                                                  
City, State, Zip                                                                                        
Social Security Number                                                                            

Date of Birth                             

Race          Sex     
Signature                                                       Date:____/____/______ 

Staftrack, Inc.
P.O. Box 1133
Largo, Florida  33779
Phone 727-581-3603  Fax 727-581-3725

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Copyright StafTrack.
Last revised: August 08, 2015