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Contractor shauld make addit'ronal copies of this form as necessary. All current employees <br /> as well as any new hires are required to complete this form and provide it to the Decatur <br /> Police Department before any tows are made by the successful Contractor. <br /> AUTHORITY TO RELEASE INFORMATION <br /> TO CITY OF DECATUR,ILLINOIS <br /> I, , (print name), hereby authorize release as directed of <br /> this information so that my criminal record will be checked by members of the Decatur Police <br /> Department and that award of the towing contract with the City may be denied based upon re- <br /> sults that my criminal history can be determined. <br /> (Please clearly print all information) <br /> Last Name First Name <br /> Middle Initial Birth Date Race <br /> Address <br /> City State Zip <br /> Telephone(Work) (Home) <br /> Signed <br /> Date <br /> Witness <br /> Date <br />