The Authorization for Release is a legal document and must be signed in front of a notary public. Download the Authorization for Release form to complete and notarize. If you apply electronically, it is often completed after your interview and before the background investigation — upload a notarized copy in Documents when you have it.

Text of the authorization

I am an applicant for a position with the Town of Talala. The Town needs to thoroughly investigate my employment background and personal history to evaluate my qualifications to hold the position for which I have applied. It is in the public’s interest that all relevant information concerning my personal and employment history be disclosed to the Town of Talala.

I hereby authorize any representative of the Town of Talala bearing this release to obtain any information in your files pertaining to my employment records, and I hereby direct you to release such information upon request of the bearer. I do hereby authorize a review of and full disclosure of all records, or any part thereof, concerning myself, by and to any duly authorized agent of the Town of Talala, whether said records are of public, private or confidential nature. The intent of this authorization is to give my consent for full and complete disclosure.

I further consent to your release, including photocopies, of any and all public and private information that you may have concerning me, my work record, my background and reputation, my military service records, my educational records, my financial status, my criminal history record, including any arrest records and any information contained in investigatory files, efficiency ratings, complaints or grievances filed against me. I further request release of attendance records, polygraph examinations and any internal affairs investigations and discipline, including any files, which are deemed to be confidential and/or sealed.

I understand my rights under Title 5 USC § 552a, the Privacy Act of 1974, with regard to access and disclosure of records, along with 51 OS § 24A.8, with regard to Open Records Act, and I waive those rights with the understanding that information furnished will be used by the Town of Talala in conjunction with employment procedures.

I hereby authorize the National Personnel Records Center, St. Louis, Missouri, or other custodian of my military record (if applicable) to release to the Town of Talala information or photocopies from my military personnel records. This could include photocopies of my DD214 Report of Separation, etc.

A photocopy of this release form will be valid as an original thereof, although the said photocopy does not contain an original writing of my signature. Should there be any questions as to the validity of this release, you may contact me at the address or phone number listed on this form.

I agree to indemnify and hold harmless the person to whom this request is presented and his agents and employees, from and against all claims, damages, losses, and expenses, including reasonable attorney’s fees, arising out of or by reason of complying with this request.

I further agree to waive any right whatsoever to the background investigation report or psychological report developed through this waiver.

Psychological evaluation: You do not fill that form now. If you are extended a conditional offer of employment or appointment you will then be required to complete the Psychological Evaluation.