I, , am making application for membership in the Pennington First Aid Squad. As a result, an investigation is being conducted to determine my eligibility. I do hereby authorize a review and full disclosure of all records and information concerning myself, whether the said records or information is of a public, private or confidential nature.
I also authorize and request every person, firm, company, corporation, governmental agency, court, association or institution having control over any documents, records, and other information pertaining to me, to furnish to the said Municipality, County Prosecutor’s Office and / or Department of Law and Public Safety any information, formal or informal, pending or closed, or any other pertinent data, and to permit the said Municipality, County Prosecutor’s Office and/or Department of Law and Public Safety or their representatives to inspect and make copies of such documents, records, and other information.
I hereby release, discharge and exonerate the said Municipality, County Prosecutor’s Office and/or Department of Law and Public Safety, their representatives and any other person furnishing information from any and all liability of every nature and kind arising out of furnishing, inspection or collecting of such documents, records and any other information or investigation made by the said Municipality, County Prosecutor’s Office and / or Department of Law and Public Safety.
I understand that any information obtained by a personal history background investigation that is developed directly or indirectly, in whole or part, upon this authorization and release will be considered in determining my suitability for membership in the Pennington First Aid Squad.
A photocopy of this authorization and release form will be as valid as an original thereof, even though the said photocopy does not contain an original writing of my signature.
I have read and fully understand the contents of the “Authorization & Release”. Signature
Social Security number