Police Officer Applicant Background Questionnaire - Sierra Vista Police Department Page 5
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24Arizona Peace Officer Standards and
Training Board
AUTHORIZATION FOR RELEASE OF INFORMATION
I ,
DO HEREBY AUTHORIZE any and all persons, employers, partnerships,
,
(print name)
corporations and all civilian and government entities, military agencies, law enforcement agencies, private, and city,
county, state and federal entities to release, furnish and exchange any and all available information relating to me for
the purpose of determining my suitability to be appointed and certified as a peace officer. This includes, but is not
limited to, all information related to my employment, performance, disciplinary history, character, integrity, reputation,
conduct, behavior and fitness for duty.
This authorizes release to the
ARIZONA PEACE OFFICER STANDARDS AND TRAINING BOARD and the (agency)
. This release is in addition to, and not
(print agency name)
I DO HEREBY RELEASE from any
intended to curtail or diminish the authorization and immunity provided by statute.
and all liability, all persons or entities disclosing information pursuant to this release.
Signature of Applicant:
Date:
Sworn and Subscribed To Before Me This:
Day of
By:
State of:
County of:
Signature of Notary Public:
AZ POST Form PH (Sept. 2015) Page 2 of 10
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