I hereby authorize the City of Belvidere and the Belvidere Board of Fire and Police Commissioners, and their authorized agents, officers, employees, investigators, or background screening providers to request, obtain, review, verify, and receive records and information concerning me for employment-related purposes.
This authorization includes records and information related to my employment history, volunteer service, references, education, training licenses, certifications, military service, driving record, criminal history, fingerprints, public records, medical history, and other lawful background information related to my qualifications, suitability, character, fitness, and eligibility for appointment or employment.
I authorize any person, medical provider, employer, agency, institution, licensing body, certification body, law enforcement agency, court, military records custodian, motor vehicle agency, or other record custodian to furnish such records or information to the City of Belvidere or its authorized representative.
Employers should not release my salary history, private social media account access, or medical or disability records.
I authorize health care providers to release medical records and information lawfully required for the hiring process, including post-offer medical examination records, psychological evaluation records, drug and alcohol screening records, immunization or communicable disease records, fitness-for-duty information, and other job-related medical information necessary to determine my ability to safely and lawfully perform the essential functions of the position.
I understand that any criminal history, consumer report, investigative consumer report, or other background information will be obtained and used only as permitted by applicable law.
On behalf of myself, my heirs and anyone who may have a claim under or through me, I release from any and all claims, causes of action and liability, to the fullest extent permitted by law, any person or entity providing or receiving the aforementioned documents and information in accordance with this release for employment-related purposes.
This authorization shall remain valid unless I revoke this authorization in writing. A photocopy, electronic copy, or facsimile of this authorization shall be valid as the original.
By entering/signing my name and date below I verify my acknowledgement of, and agreement to, the above statements. I understand that if I refuse to execute and return this Release, the City of Belvidere will have insufficient information regarding my application, and I will be removed from the application process.