TO WHOM
IT MAY CONCERN:
I,
! !
. I hereby expressly authorize the release of any and
all information of a confidential or privileged nature, including confidential
criminal justice information as defined in Section 44-5-103(3), MCA, to
the staff of the !
and its agents.
Have
you been convicted or adjudicated of any crime in any jurisdiction besides
minor traffic offenses?
-Y/N-
Yes
No
Attached,
if necessary is a complete description of the circumstances surrounding
the crime(s) of which I have been convicted or adjudicated in any jurisdiction.
I acknowledge that I have the right to obtain a copy of the fingerprint
background check obtained by the District and to challenge its accuracy
if necessary. I further acknowledge that my access to children may be
denied prior to completion of the fingerprint background check.
I hereby
release the !
and any organization, company, institution, or person
furnishing information to the district and its agents as expressly authorized
above, from any liability for damage which may result from any dissemination
of the information requested, subject to the provisions of Title 44, Chapter
5, Part 3, MCA. A fingerprint background check will be at my expense and
will be deducted from the initial paycheck unless other arrangements are
made with the District Office.
This
document is effective until revoked in writing by me.