I hereby give my permission to contact the above employers, references and educational institutions to verify that items I listed above. I hereby release St. Louis Center and the above referenced organizations, reference persons and employers from all claims, liability and damages that may result from furnishing the information to you. I expressly and fully waive all written notice from all prior employers. I consent to releasing any information relating to my job performance which is documented in my personnel file.
I also understand that because of the nature of my job and licensing requirements, I hereby consent to the release of this application or portion of this application to representatives of the Department of Consumer and Industry services, Family Independence Agency, Department of Community Health, and local Community Mental Health agencies, or other governmental or private agencies for all licensing or investigatory purposes and to verify information I have listed in this job application. I hereby release St. Louis Center, the Department of Commerce, Family Independence Agency, Department of Community Mental Health, the local Community Mental Health agencies and other various governmental or private agencies from all claims, liability, and damages that may result from furnishing the information to you.
I further specifically waive written notice and agree to the divulging of any disciplinary reports, letters of reprimand or other disciplinary action by all prior employers, and hereby release my prior employers from all claims, liability and damages that may result from furnishing the information to you.