Absolutely Clean: form

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ABSOLUTELY CLEAN

BACKGROUND AUTHORIZATIONS

I have no criminal record in Washington or any other state, excluding minor traffic violations. (You can have a record even though there was no conviction.)

Signature ___________________________Date _______________
I authorize ABSOLUTELY CLEAN to run a computer check through the local police department or other law enforcement agencies to confirm the above signed statement.

Signature ___________________________Date _______________

Driver’s License Number _______________________________________
State Number
I fully understand that:

A) The client checks I collect upon completion of each job include both my
pay and the fees ABSOLUTELY CLEAN receive from the client;

B) I must return ABSOLUTELY CLEAN’s portion weekly; and that

C) Failure to return ABSOLUTELY CLEAN’s fees is stealing and may be
punishable as a felony.

Please identify two verifiable contacts on the spaces provided below who may be of assistance to ABSOLUTELY CLEAN and local police should you not return ABSOLUTELY CLEAN’s client fees at any time.

1. Name and Address (parent or relative) ________________________________

Phone (

) ______________________

2. Name and Address (parent or relative) ________________________________

Phone (

) ______________________

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