Common use of AUTHORIZATION AND RELEASE Clause in Contracts

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 allegation/investigation of child abuse/neglect or domestic violence, or have otherwise been involved in any act or received notification from the Family Advocacy Program of an incident that met Department of Defense criteria for child maltreatment or domestic abuse? Mark Yes or No for each category. I also understand that if I am a family child care provider that I will make the same report for the same offenses for members in my household. WARNING: False statements are punishable by law and could result in fines and/or imprisonment for up to five years. a. SIGNATURE b. DATE SIGNED (YYYYMMDD)

AUTHORIZATION AND RELEASE. CERTIFICATION In connection with my employment or application for employment with (the company), I hereby authorize understand that a consumer report and/or an investigative consumer report may be requested, which may include the Department following types of Defense information: names and other authorized federal agencies to obtain any dates of previous employers, salary, licensure, accidents, work experience, along with reasons for termination of past employment, credit (except California), etc. I understand that as directed by Company policy and consistent with the job described with the Company, you may be requesting information required from public and private sources which may include the Federal governmentfollowing types of information, state agencies, and/or foreign governments, including but not limited to: workers compensation claims, the Federal Bureau of Investigation driving record, criminal records, education, military records (FBIDD214), judgments, bankruptcy proceedings, references, etc., from federal, state, counties and other agencies which maintain such records. In addition, investigative consumer reports as defined by the Defense Counterintelligence federal Fair Credit Reporting Act, gathered from personal interviews with former employers and Security Agency (DCSA)other past or current associates of mine to gather information regarding my work performance, the U.S. Office of Personnel Management (OPM)character, the Department of Homeland Security (DHS), (if applicable), general reputation 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 soonerpersonal characteristics may be obtained. I have been notified the right to make a request to AAIM EA TRAINING AND CONSULTING LLC, the consumer reporting agency at 0000 X. Xxxxxxxxx Xxxx., Xxxxx 000, Xx. Xxxxx, XX 00000 or by phone 000-000-0000, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information and the agency will provide a complete and accurate disclosure of the nature and scope of the investigation covered by the investigative consumer report(s); and the recipients of any reports on me which the agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to the Company obtaining the above information from the agency. I understand I may view their privacy policy at their website: xxx.xxxxxx.xxx. I voluntarily and knowingly authorize the Company and/or its agents, to verify any aspect of the information contained in my employment application or through public and private sources. I further understand that misrepresentations or omissions in my employment application may be cause for rejection or may be cause for subsequent dismissal if I am hired. I voluntarily and knowingly authorize any former employer’s , person, firm, corporation, school or Agency's right government agency, its officers, employees and agents to require a criminal history records check as a condition of employment, release any and all information concerning my former employment to the Company or affiliation with DoD Child Care Services Programsits agents. I understand that the employment information may include, but is not necessarily limited to, performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it. I may request voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless the Company, its agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to the Company, its agents, or consumer reporting agency. You have the right to inspect and promptly receive a copy of such records as may be available any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. You have the right, upon written request to me under the lawAgency, to receive a complete and accurate disclosure of the nature and scope of any consumer report. I understand that I The Agency must make this disclosure within five days of receipt of your request or of the Company's request for the report, whichever is later. You have a the right to challenge request whether the accuracy and completeness of any information contained in the criminal history records check report. I also understand that pursuant to the Privacy ActCompany requested a consumer report and, if so, the information collected Company will be safeguarded, including for give you the purpose of conducting the background check. I release any individual, including records custodians, any component name and address of the United States Government or report's provider if other than 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 $300Agency.). In addition, I will immediately report when I am aware of a current allegation/investigation of child abuse/neglect or domestic violence, or have otherwise been involved in any act or received notification from the Family Advocacy Program of an incident that met Department of Defense criteria for child maltreatment or domestic abuse? Mark Yes or No for each category. I also understand that if I am a family child care provider that I will make the same report for the same offenses for members in my household. WARNING: False statements are punishable by law and could result in fines and/or imprisonment for up to five years. a. SIGNATURE b. DATE SIGNED (YYYYMMDD)