WAYNE COUNTY SHERIFF’S OFFICE
AUTHORITY TO RELEASE INFORMATION

I authorize representatives and agents of the Wayne County Sheriff’s Office to investigate all statements contained in this application, including records of any former employers, police departments, courts, my complete and unedited criminal history, and other references or sources concerning me. I authorize all such references and sources (and any company) to release this information without liability for damage resulting from such release. I waive any written notice of the release of such records that may be required by state or federal law.

I authorize a review of and full disclosure of all records, or any part thereof, concerning myself, by and to ANY duly authorized agent of the Wayne County Sheriff’s Office, within one year of its’ date, whether the said records are public, private, or confidential.

The intent of this authorization is to give my consent for full and complete disclosure of information including but not limited to: military records, the records of educational institutions, financial or credit institutions, public utility companies, employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me, salary records, real and personal property tax statement and records, and other financial statements and records wherever filed; records of complaint, arrest, trial and/or convictions for alleged or actual violations of law, including criminal, civil, and/or traffic records, records of complaint of a civil nature made by or against me, wheresoever filed.

I reiterate an emphasize that the intent of this authorization is to provide full and free access to the background and history of my personal life, for the specific purpose of pursuing a background investigation, which may provide pertinent data for the Wayne County Sheriff’s Office to consider in determining my suitability for employment by that department. It is my specific intent to provide access to personal information, however personal or confidential it may appear to be, and the sources of information specifically identified herein.

I understand that any information obtained by a personal history background investigation, which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability for employment by the Wayne County Sheriff’s Office. I understand that all materials pertaining to this background investigation become the property of the Wayne County Sheriff’s Office and will not be returned to me.

I agree to indemnify and hold harmless the person to whom this request is presented and his agents, employees and related personnel, both individually and collectively, from and against all claims, damages, losses and expenses, including reasonable attorney fees arising out of or by reason of complying with this request. I further understand that in the event my application is disapproved, the sources of confidential information cannot be revealed to me.

A photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an original writing of my signature.