Release And Waiver - Sacramento County Sheriff'S Department printable pdf download

SACRAMENTO COUNTY

SHERIFF’S DEPARTMENT

OLUNTEERS

ARTNERSHIP WITH THE

HERIFF

JOHN MCGINNESS

Sheriff

NON-SWORN PERSONNEL

RELEASE AND WAIVER

TO WHOM IT MAY CONCERN:

I hereby authorize any Sheriff’s Deputy or other authorized representative of the Sacramento

County Sheriff’s Department bearing this release, or a copy of it, within one year of it’s date, to

obtain any information in your files pertaining to my employment, credit or educational records

including, but not limited to, academic achievement, attendance, athletic, personal history,

performance report, background investigations, polygraph examination results and any and all

internal affairs investigations and disciplinary records, credit records, medical records and

psychological records.

I hereby direct you to release this information upon request of the bearer. This release is

executed with full knowledge and understanding that the information is for the official use of the

Sacramento County Sheriff’s Department.

Consent is granted for the Sacramento County Sheriff’s Department to furnish the information

described above to third parties in the course of fulfilling its official responsibilities.

I hereby release you, as the custodian of such records, any school, college, university or other

educational institution, credit bureau, lending institution, consumer reporting agency, retail

business, any physician, psychologist, psychiatrist, medical facilty or any establishment

including its officers, employees or related personnel both individually and collectively, from

any and all liability for damage of whatever kind, which may at any time result to me, my heirs,

family and associates because of compliance with this authorization and request to release

information or any attempt to comply with it. Should there be any questions as to the validity of

this release, you may contact me as indicated below.

I understand that I have the right to receive a copy of this authorization and acknowledge that I

have received a copy of it.

FULL NAME:_______________________________________________DATE:_____________

SIGNATURE

FULL NAME:__________________________________________________________________

TYPE OR PRINT

PHONE NUMBER: DAY___________________________EVENING_____________________

VOLUNTEER APPLICATION-APPENDIX C

REFER ALL CORRESPONDENCE TO: SACRAMENTO SHERIFF’S DEPARTMENT • VOLUNTEER COORDINATOR•711 G STREET • SACRAMENTO, CA 95814

Release And Waiver - Sacramento County Sheriff'S Department