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“For Official use Only – Privacy Sensitive: Any misuse or unauthorized disclosure may result in both civil and criminal penalties: CALIFORNIA APPLICANT’S NAME: GOVERNOR’S OFFICE POSITION: Selective Service System Local Board Member APPOINTMENTS UNIT Area Office No.: Local Board No.: DATE: FIRST NAME: MIDDLE NAME: LAST NAME: SEX: DATE OF BIRTH: NAME OF SPOUSE: SOCIAL SECURITY NO.: DRIVER’S LICENSE NO.: RESIDENCE STREET: RESIDENCE CITY: RESIDENCE ZIP CODE: RESIDENCE TELEPHONE NO.: VOTER REGISTRATION (COUNTY): (PARTY): OCCUPATION: TITLE: BUSINESS FIRM: BUSINESS STREET: BUSINESS CITY/STATE/ZIP CODE: BUSINESS TELEPHONE NO.: ETHNICITY (OPTIONAL): CONSUMER CREDIT REPORT DISCLOSURE In accordance with Federal consumer legislation, Section 604(b)(2)(A)(ii) of the FCRA, your permission is required to obtain a Consumer Credit Report. BY SIGNING BELOW, YOU ARE GIVING YOUR PERMISSION FOR THE CALIFORNIA GOVERNOR’S OFFICE APPOINTMENTS UNIT TO OBTAIN YOUR CONSUMER CREDIT REPORT. SIGNATURE: DATE: SIGN