Having made application with the City of Pearl for employment, and desiring them to be informed of my past record, whether it be financial, academic, military, employment, judicial, criminal, driving record or personal reference, I the undersigned, hereby authorize the release of all such information, privileged, confidential or otherwise, to the City of Pearl and its representatives.
I hereby release all contributing parties of such information from liability or damages that may result from furnishing the information requested, including any liability or damage pursuant to any state or federal laws. I understand my rights under Federal and State Law with regard to access and disclosure of records, and I waive these rights with the understanding that information furnished will be used by the City of Pearl in conjunction with employment procedures. While I acknowledge that this release shall be construed as broadly as lawfully possible, I understand that nothing in this release is intended to waive rights that cannot by law be released.
A photocopy or fax copy of this release form will be valid as an original thereof, even though said photocopy or fax copy does not contain an original writing of my signature.