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I, _________________________________________, DO HERBY AUTHORIZE any and all persons, employers, partnerships, corporations and all civilian and government entities, military agencies, law enforcement agencies, private, and city, county, state and federal entities to release, furnish and exchange, any and all available information relating to me for the purpose of determining my suitability to attend a voluntary Citizen's Police Academy for the Town of Prescott Valley Police Department. This includes, but is not limited to, all information related to my employment, performance, disciplinary history, character, integrity, reputation, conduct, behavior, and fitness for duty.
This authorizes release to the Town of Prescott Valley Police Department. this release is in addition to, and not intended to curtail or diminish, the authorization and immunity providing by statue. I DO HEREBY RELEASE from any and all liability, all persons or entities disclosing information pursuant to this release.
STATE OF ARIZONA
County of Yavapai
Subscribed and sworn to (or affirmed) before me this ________ day of _____________, 20__,
Notary Public ____________________________________
My Commission Expires __________________________
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