MAGISTRATE APPLICATION — AUTHORIZATION FOR RELEASE OF INFORMATION JD-ES-279 New 2-11 STATE OF CONNECTICUT JUDICIAL BRANCH Confidential Record & Reference Check Magistrates www.jud.ct.gov By my signature*, I authorize the Judicial Branch to obtain from any source it deems appropriate including, but not limited to, schools, employers and criminal justice agencies, information relevant to my qualifications for appointment as a magistrate. This information may include, but is not limited to, my academic achievement, performance, attendance, disciplinary, employment history, and criminal history record information. I further authorize those contacted to provide appropriate information. Print name of person signing at left Signature Ξ Date signed Date of birth Social Security number Date Witness *Copies of this authorization that show my signature are as valid as the original release signed by me. Print Form Reset Form American LegalNet, Inc. www.FormsWorkFlow.com