If you answered yes to any one of the previous six (6) questions, please attach a written explanation, including the date of the incident, charges, any court action, the offense in question and the address of any court involved. Please note that criminal convictions that have been lawfully expunged are not required.
I hereby authorize you to release to Central Nine Career Center, Greenwood, Indiana, any and all personal and employment records pertaining to my employment by your company, including but not limited to, my application for employment, work records and performance evaluations. I also authorize the Indiana State Police, the Police Department, County Sheriff’s Department or the Federal Bureau of Investigation to release to Central Nine Career Center files pertaining to me.
I have read this authorization and release of all claims, and I expressly agree to the terms set out herein and in sections VI and VII of this application. I also understand that falsification of facts on this application shall be considered sufficient cause for disqualification or dismissal. References and personal information which become part of this record are to be regarded as confidential and will not be revealed.
Note: A photocopy of this authorization shall be as valid and binding as the original.