White Bear Lake School District Employee Criminal Background Check Form Page 2

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REQUEST FOR EXEMPTION FROM CRIMINAL BACKGROUND CHECK 
 
I hereby request exemption from the criminal background check at this time based on the following: 
 
_______  I am less than 18 years of age.  (Date of Birth:  ____________________) 
 
Print Full Name: 
__________________________________________________________________________ 
 
________________________________________________ 
____________________________ 
 
Signature of Applicant 
Date 
 
 
 
 

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