AUTHORIZATION AND RELEASE. CERTIFICATION I hereby authorize the Department of Defense and other authorized federal agencies to obtain any information required from the Federal government, state agencies, and/or foreign governments, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Counterintelligence and Security Agency (DCSA), the U.S. Office of Personnel Management (OPM), the Department of Homeland Security (DHS), (if applicable), and from the State Criminal History Repository for each state where I have resided. This authorization is valid for one year from the date this form was signed or until termination of my affiliation with the Federal Government, whichever is sooner. I have been notified of any employer’s or Agency's right to require a criminal history records check as a condition of employment, or affiliation with DoD Child Care Services Programs. I understand that I may request a copy of such records as may be available to me under the law. I understand that I have a right to challenge the accuracy and completeness of any information contained in the criminal history records check report. I also understand that pursuant to the Privacy Act, the information collected will be safeguarded, including for the purpose of conducting the background check. I release any individual, including records custodians, any component of the United States Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of good-faith compliance, or any good-faith attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me. I declare under penalty of perjury that the statements made by me on this form are true, complete and correct. In addition to the annual certification, I understand that it is my responsibility to immediately inform my employer/supervisor or Child and Youth Programs representative if I am apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law (including the Uniform Code of Military Justice), State law, County law, or Municipal law with a crime referenced in block 6. (Do not include traffic fines of less than $300.). In addition, I will immediately report when I am aware of a current al...
AUTHORIZATION AND RELEASE. In no event shall the Vendor deliver goods or provide service until such time as a duly authorized release document is certified by the ordering Agency. A Direct Purchase Order (DPO) shall be created by the agency listing the items ordered, using the pricing and format set forth in the Master Blanket. All pricing shall be as described in the Master Blanket and is considered to be fixed and firm for the term of the Agreement, unless specifically noted to the contrary herein. All prices include prepaid freight. Freight, taxes, surcharges, or other additional charges will not be honored unless reflected in Master Blanket. DELIVERY OF GOODS OR SERVICES AS REQUESTED BY AGENCY. PAYMENTS WILL BE AUTHORIZED UPON SUBMISSION OF PROPERLY RENDERED INVOICES NO MORE THAN MONTHLY TO THE RECEIVING AGENCY. ANY UNUSED BALANCE AT END OF BLANKET PERIOD IS AUTOMATICALLY CANCELLED. THIS PURCHASE ORDER IS AWARDED SUBJECT TO EQUAL OPPORTUNITY COMPLIANCE.
AUTHORIZATION AND RELEASE. Examiners should obtain an examinee’s agreement, in writing and/or on the audio/video recording, to a waiver/release statement. The language of the statement should minimally include 1) the examinee's voluntary consent to take the test, 2) that the examination may be terminated at any time, 3) a statement regarding the examinee’s assessment of his or her mental and physical health at the time of the examination, 4) that all information and results will be released to professional members of the community supervision team, 5) an advisement that admission of involvement in unlawful activities will not be concealed from the referring professionals and 6) a statement regarding the requirement for audio/video recording of each examination.
AUTHORIZATION AND RELEASE. I hereby authorize all previous employers and references to release to the City of Groton, any and all employment and personnel information requested, including, but not limited to my personnel file(s). I hereby also specifically release and hold harmless the City of Groton, or any former employer and its employees and/or agents from any and all claims or liability as a result of releasing such information.
AUTHORIZATION AND RELEASE. The undersigned hereby represents and warrants that he or she is duly authorized to execute and deliver this application on behalf of its organization and agrees to assume all risks and responsibilities surrounding participation in the 2015 CultureFest and further to release the University of Denver and all departments and divisions thereof from any claims, demands, actions, causes of action, lawsuits, expenses, or losses (including court costs and all reasonable attorney fees) he or she may have on account of property damage or personal injury (including death) arising out of or attributable to participation in the 2015 CultureFest, unless such property damage or personal injury or death is caused by the negligence of the University of Denver, its trustees, employees or agents. The undersigned, on behalf of his or her organization has read, understands, and agrees with the enclosed rules and regulations and takes full responsibility for the activities conducted in the assigned booth area. The undersigned xxxxxx agrees that his or her organization will comply with the rules of the 2015 CultureFest. Upon acceptance by the CultureFest Planning Board, your booth application shall be a contract for participation at the 2015 CultureFest. You will be considered in default of your obligations under this agreement if you should fail to observe, to comply with, or to perform any term or condition contained in this agreement. Representative’s Signature: Date: Representative’s Printed Name: Initials: Mission: The CultureFest, sponsored by the CultureFest Planning Board at the Colorado Seminary, which owns and operates, the University of Denver, University of Denver, is an event intended to support the sharing, celebration, and appreciation of diverse cultural backgrounds, customs, and experiences among members of the University of Denver and surrounding Denver community. The event seeks to support internationalization and to xxxxxx inclusivity along with a climate of respect and appreciation of differences. Initials General CultureFest Attendance and Participation Policies, Rules, & Requirements
AUTHORIZATION AND RELEASE. Home Owner agrees to cooperate with University in providing and obtaining information necessary to make a determination whether a Repurchase Option Event may have occurred. Home Owner hereby authorizes University to obtain whatever information may be required from third parties for University to make such determination, including, without limitation, the University and any other employer of Home Owner. University agrees to utilize any such information so obtained only for such purpose and, if applicable, for implementing University’s rights under this Section 3.7.5.
AUTHORIZATION AND RELEASE. I acknowledge receipt of the Disclosure regarding the background investigation and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the procurement of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this authorization and, if I am hired (or contracted), this Authorization shall remain on file and serve as ongoing authorization throughout my employment (contract) with the company. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by AAIM EA TRAINING AND CONSULTING LLC, 0000 X. Xxxxxxxxx Xxxx., Xxxxx 000, Xx. Xxxxx, XX 00000, Phone: 000-000-0000 / 000-000-0000, Fax: 000-000-0000, any another outside organization acting on behalf of the Company, and/or the Company itself. NOTICE REGARDING BACKGROUND CHECKS PURSUANT TO CALIFORNIA LAW Section 750. Definitions. 751. Applicability.
AUTHORIZATION AND RELEASE. I authorize release of any information relating to my family’s dental claims to my insurance company of record during the period of such dental care.
AUTHORIZATION AND RELEASE. I have read and fully understand the policies as outlined above. I understand and agree that I am ultimately responsible for the balance on my account and agree to all of the terms that are outlined for the plan I have chosen. In the event it is necessary to turn my account over to collections, I have been made aware that I am completely responsible for any and all costs associated with the collections process.
AUTHORIZATION AND RELEASE. I hereby give permission to Southeast Georgia Health System and its agent to verify the information submitted by me and to obtain a criminal history. Neither the Health System nor its’ agent shall be violating my right to privacy in any manner and I release them from all liability whatsoever for actions related to the background investigation. I authorize release of this information to the appropriate representative(s) of Southeast Georgia Health System. (Name of Hospital Department, Company, Organization, Agency, Contractor, Vendor, Service Provider, Educational Institution/Organization, other entity, etc...)
