Fill and Sign the Prince Georges County Fireems Department Personnel Record Form

AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION I, ______________________________________________________________________, First Middle Last Race Sex DOB SSN am an applicant for the position of with . I authorize a review and full disclosure of all records, or any part thereof, about me to any authorized personnel of , whether the records are public or private, even if the records may be otherwise considered to be privileged or confidential. I intend this authorization to be used in providing information that will be used to determine my suitability for employment with . This authorization is for the records of educational institutions; medical, psychological, and psychiatric consultation, and/or treatment; all military, selective service, and employment records; financial or credit institutions, credit reports or ratings; and criminal and/or traffic records. All information in my application for employment with is true and complete to the best of my knowledge. I understand that all of the information in the application will be investigated. Any inaccurate, untruthful or misleading statements will be a reason for immediate rejection of the application without appeal. If I need to update my application, I will send or bring the information to . A photocopy of this release will be valid as the original, even though the photocopy does not contain my original signature. I agree to indemnify and hold harmless and all persons from all claims, demands, causes of action, damages, losses, and expenses arising out of or because of any matter relating to this authorization. _________________________________ ______________________________ Applicant's Full Legal Signature Witness _____________________________________ _________________ Address Date _____________________________________City, State, Zip
Mr. , i have been informed that i am being interviewed by to be a , and I understand that i will be applying for a job with him. I have not yet made my appointment with Mr. But i feel that a satisfactory interview could be made in the next 14 days. I would be remiss if I did not inform you of the circumstances that are concerning me and that are affecting my decision as to the future of my employment with your organization. As you know my father has Alzheimer's disease. He has been on a fixed income for years due to hernia surgery. He is the sole provider for my mother and for himself. Furthermore, he now needs assistance with his finances, and as a result he cannot provide adequate care for the family. My mother has a terminal illness and my father has been unable to provide her any type of medical attention. In addition, as the result of your policy, I have decided to retire from my position with him in November. I realize that i may not have another opportunity and I do not plan to retire after i have had the opportunity to interview with . I have had the opportunity of two different interviews and both times, I had very positive experiences. The most successful interview was with. I thought that i did very well and i am hoping I did not offend him although that was not my intention at all. I have been informed by my secretary that I will not have access to her personnel file or to any files which may relate to. I know that any other organization is not required to allow me to obtain any information regarding others that are applying for employment. This policy is a barrier to my gaining employment. I know that I need to be candid with you as i intend to make the best possible use of any opportunities that you may consider offering, provided that it is within the parameters of your policy on all applicants. I am sure that I did not offend mr. But my reason for applying for this position is that I consider myself very qualified for this position due to my extensive experience and my qualifications as a navy veteran. As a Vietnam veteran, i understand that you do not have the right to discriminate on the basis that I am a former marine but i know you do have the right to discriminate on the basis that my military record may contain information that may be deemed inappropriate or damaging. In regard to this policy,