Legal Criminal History Release Form

LEGAL CRIMINAL HISTORY RELEASE FORM

This Criminal History Release ("Release") is made and entered into on Execution Date: by and between Requesting Party: and Subject Name: .

Subject Date of Birth: Subject SSN (last 4):

RECITALS

WHEREAS, Requesting Party seeks to obtain criminal history records, conviction data, arrest records, or other public safety records (collectively "Records") pertaining to Subject for the purpose identified herein; and

WHEREAS, Subject is the individual identified above and is willing to authorize release of Records to Requesting Party in accordance with the terms and limitations set forth in this Release; and

WHEREAS, Requesting Party requires a written authorization to obtain, review, and use such Records for legitimate purposes and agrees to the limitations and obligations set forth below.

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, and other good and valuable consideration, the parties agree as follows:

1. AUTHORIZATION TO RELEASE RECORDS

Subject hereby authorizes and directs any law enforcement agency, court, correctional facility, state or local repository, administrative agency, or other public or private entity holding Records to release such Records to Requesting Party and its authorized agents, contractors, and representatives. This authorization includes all Records relating to arrests, charges, convictions, deferred adjudications, dispositions, probation, parole, and outstanding warrants. Subject specifically authorizes the release of Records regardless of whether those Records may otherwise be restricted or sealed, to the extent permitted by applicable law.

2. SCOPE AND PURPOSE

The Records requested shall be used solely for the following purpose:

Requesting Party represents that the Records will not be used for any purpose prohibited by law and that any adverse action taken on the basis of such Records will comply with applicable legal requirements.

3. INFORMATION TO BE RELEASED

The Records to be released may include, without limitation: arrest records, criminal charges, court dockets, conviction records, sentencing data, probation and parole information, booking photographs, fingerprint records, and disposition documents. Requesting Party acknowledges that the content, completeness, and existence of Records is determined by the custodian of the Records.

4. CONSENT TO FINGERPRINTING AND BACKGROUND CHECK

Subject consents to fingerprinting and a nationwide criminal background check if requested by Requesting Party or required by law for the purpose stated herein. Subject understands that fingerprints or other biometric identifiers may be submitted to state and federal repositories for processing.

I consent to fingerprinting and background check as described above

5. ACKNOWLEDGEMENT, WAIVER AND RELEASE

Subject acknowledges that the disclosure of Records may include information that is derogatory or sensitive. Subject waives any claim for defamation, invasion of privacy, or other civil claim against Requesting Party and any Record custodians arising from the release or use of Records in accordance with this Release, except to the extent caused by intentional misconduct or gross negligence.

6. REPRESENTATIONS AND WARRANTIES

Subject represents and warrants that the information provided in this Release is true and correct to the best of Subject's knowledge, including name variations and prior addresses identified below. Subject further represents that he or she has the legal capacity to execute this Release.

7. DURATION AND REVOCATION

This Release shall be effective on the Execution Date set forth above and shall remain in effect until Expiration Date: unless earlier revoked in writing. Revocation by Subject shall be effective only upon receipt by Requesting Party and shall not apply to Records already released in reliance on this Release prior to the effective date of revocation.

8. CONFIDENTIALITY AND PERMITTED USE

Requesting Party agrees to keep Records confidential to the extent required by applicable law, to use Records only for the purpose stated in this Release, and to implement reasonable safeguards to prevent unauthorized disclosure. Requesting Party will not disseminate Records beyond its agents and representatives who have a need to know for the stated purpose.

9. INDEMNIFICATION

Requesting Party shall indemnify, defend, and hold harmless Subject and any Record custodian from any claims, liabilities, losses, damages, or expenses (including reasonable attorneys' fees) arising out of Requesting Party's misuse, negligent disclosure, or unlawful dissemination of Records obtained pursuant to this Release, except to the extent caused by the intentional misconduct or gross negligence of Subject or the Record custodian.

10. NOTICES

All notices required or permitted under this Release shall be in writing and delivered to the addresses set forth below by certified mail, courier, or hand delivery and shall be effective upon receipt.

11. GOVERNING LAW

This Release shall be governed by and construed in accordance with the laws of the jurisdiction where Requesting Party is located, without regard to conflict of law principles. Any action to enforce this Release shall be brought exclusively in the state or federal courts located in that jurisdiction.

12. ENTIRE AGREEMENT

This Release constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written.

13. SEVERABILITY

If any provision of this Release is held to be invalid, illegal, or unenforceable in any respect, the validity, legality, and enforceability of the remaining provisions shall not be affected or impaired thereby.

14. AMENDMENT AND WAIVER

No amendment, modification, or waiver of any provision of this Release shall be effective unless in writing and signed by both parties. No waiver by either party of any breach shall constitute a waiver of any subsequent breach.

15. COUNTERPARTS

This Release may be executed in one or more counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. A facsimile, electronic image, or other reproduction of an original signature shall be deemed to be an original signature for all purposes.

CERTIFICATION

By checking the box below and signing this Release, Subject certifies under penalty of perjury under the laws of the governing jurisdiction that the information provided herein is true and correct and that Subject has read and understands the terms of this Release.

I certify under penalty of perjury that the foregoing is true and correct.

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