Authorization to Release Information
I hereby certify that all entries on this application are true and complete to the best of my knowledge, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any appointment in the service of Warren County.
I hereby authorize any investigator or duly accredited representative of the County of Warren, Virginia, bearing this release, or a copy thereof, within one (1) year of its date, to obtain any information from schools, residential management and/or credit agents, employers, criminal justice agencies, or any individual or business that can attest to my personal or professional activities. This information may include, but is not limited to, academic achievement, performance, attendance, personal history, training, disciplinary actions, credit, driving, criminal, civil court records and conviction and arrest records.
I hereby authorize and request your release of such information upon request of the bearer. I understand that the information released is for official use only by authorized agents of the County of Warren, Virginia, as necessary in the fulfillment of official responsibilities.
I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply with this authorization. Should there be any question as to the validity of this release, you may contact me as indicated herein.
Applications will remain on file for one year. All applicants to Warren County positions for citizen appointment are afforded equal opportunity without regard to race, religion, sex, gender identity, national origin, disability, marital status, ethnic background, or political affiliation.