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Applicant’s Statement & Authorization for Release of Information
I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMMISSSION OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED. IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT THAT TIME.
I hereby authorize any investigator or duly accredited representative of the Company bearing this release to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals, relating to my activities. This information may include, but is not limited to, academic residential, achievement, performance, attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information release is for official use by the Company and may be disclosed to such third parties 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.
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2450 E. 70th St.,Shreveport, LA 71105