(Some districts require final candidates to be background checked as well as pay for their own background check. Candidates should contact applicable districts to determine background check status and costs.)

I,____________________________, and seeking employment with the __________________________ School District ("District"). I acknowledge that a complete investigation into my background is necessary to protect the safety and welfare of the children in the District. I hereby expressly and voluntarily give the District the right to make a thorough investigation of my past employment, education and activities. I specifically authorize the release of any and all information of a confidential or privileged nature, including criminal justice information as defined in section 44-5-103(3), and 41-3-205(3)(0) MCA, to the staff of the District and its agents. I understand that the District reserves the right to use any lawful method of investigation that, in its sole desecration, it deems reasonable and necessary.

I hereby release the District and any organization, company, institution, or person furnishing information to the district and its agents as expressly above, from any liability for damage which may result from any dissemination of the information requested above subject to the provision of Title 44, Chapter 5, Part 3, and Title 41, Chapter 3, MCA

This document is effective until revoked in writing by me.

PRINT FULL NAME: ________________________________________________________

PRINT FULL ADDRESS: _____________________________________________________

                                          _____________________________________________________
                                          City                                                 State                    Zip

ANY OTHER NAMES UNDER WHICH YOU HAVE BEEN EMPLOYED:
___________________________________________________________________________
___________________________________________________________________________

BIRTH DATE:__________________  SOCIAL SECURITY NUMBER:__________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

STATE OF______________________

COUNTY OF:____________________________

       On this _____ day of _____________, ______, before me, a notary public of the State of ____________, personally appeared __________________________________, known to me to be the person named in the foregoing release, and acknowledge to me that _________________________________ executed the same as ___________________________ free act and deed, for the uses and purposes therein mentioned.

       IN WITNESS THEREOF, I hereunto set my hand and affixed my notorial seal the day and year in this certificate first above written.

                                                                           __________________________________ 
                                                                           Notary Public Signature
                                                                           State of ____________________________
                                                                           County of  __________________________ 
                                                                           My commission expires ________________