AUTHORITY FOR RELEASE.pdf
PDF 38 KB Posted
- Attached to
- 14, OAG Janitorial Svs - Wilkes Barre
- Solicitation number
- 6100043603
- Issued by
- Luzerne County, Woodcock Borough, Pennsylvania
About this file
This document is an Authority for Release of Information and Records form for a temporary contractual appointment with the Pennsylvania Office of Attorney General. The form authorizes the release of information and records, including academic, residential, employment, financial, credit, and criminal information, to a duly authorized representative of the Pennsylvania Office of Attorney General. The information will be used to assist the Office of Attorney General relative to the individual's temporary contractual appointment. This authorization is valid for five years from the date signed or upon the termination of the individual's affiliation with the Pennsylvania Office of Attorney General, whichever is sooner.
The document does not provide any details regarding a state or local contract opportunity, such as products or services requested, project overviews, item quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, or the term of the contract including any renewal options. Additionally, the document does not contain information about pricing terms, set asides, incumbents, current environment, funding requirements and sources, or any other salient details related to a state or local contract opportunity.
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Text version
JOSH SHAPIRO
ATTORNEY GENERAL
COMMONWEALTH OF PENNSYLVANIA
OFFICE OF ATTORNEY GENERAL
AUTHORITY FOR RELEASE OF INFORMATION AND RECORDS FOR TEMPORARY
CONTRACTUAL APPOINTMENT WITH THE PENNSYLVANIA OFFICE OF ATTORNEY GENERAL
I hereby authorize and consent to the release of any information and records relating to my activities from individuals, schools, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection agencies, retail business establishments, or other sources of information, to a duly authorized representative of the Pennsylvania Office of Attorney General.
This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary, salary, employment, financial, credit, and criminal information.
This authorization includes permission to obtain copies and abstracts of records and information regarding my background.
The information and records will be used to assist the Office of Attorney General relative to my temporary contractual appointment with the Office of Attorney General as per the agreement between and the Office of Attorney General.
Copies of this authorization that show my signature are as valid as the original release signed by me.
This authorization is valid for five (5) years from the date signed or upon the termination of my affiliation with the Pennsylvania Office of Attorney General, whichever is sooner.
PRINT NAME (PLEASE INCLUDE FORMER NAMES)
ADDRESS
SOCIAL SECURITY
DATE OF BIRTH
SIGNATURE
DATE
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