"Authorization for Release of Information" - North Carolina

Authorization for Release of Information is a legal document that was released by the North Carolina Department of Justice - a government authority operating within North Carolina.

Form Details:

  • Released on March 28, 2017;
  • The latest edition currently provided by the North Carolina Department of Justice;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the North Carolina Department of Justice.

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Download "Authorization for Release of Information" - North Carolina

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Revised: 03/28/2017
Authorization for Release of Information
To North Carolina Criminal Justice Education
& Training Standards Commission
To Whom It May Concern:
I am an applicant for criminal justice officer certification or a certified officer with
the North Carolina Criminal Justice Education & Training Standards Commission.
In order to determine my suitability for certification or continued certification, I
understand that the North Carolina Criminal Justice Education & Training
Standards Commission must make a thorough investigation of my personal records
and personal background. It is in the public’s interest that all relevant information
concerning my personal and employment history be disclosed to the above agency.
Therefore, I, _______________________________________, DOB, _____________,
Operators License #____________________________, do hereby and authorize any
bank, credit union, lending or financial institution, credit bureau, consumer report
agency, retail business establishment, former and present employer, educational
institution, doctor or other health care professional including mental health, alcohol
treatment center, hospital or other repository of medical records, insurance company,
governmental agency, criminal or civilian courts, certification/licensing commission,
military organization, National Personnel Records Center, Air Force Personnel
Center, Air Reserve Personnel Center, Coast Guard Personnel Center, Marine Corps
Manpower Management Records & Performance, Marine Forces Reserve, Army
Human Resources Command, Navy Personnel Command, Department of Veterans
Affairs, Division of Commissioned Corps Officer Support, and any other individual
agency to produce and provide copies of any and all information to the North
Carolina Criminal Justice Education & Training Standards Commission regarding
me, whether of a privileged or confidential nature.
Moreover, I hereby release the North Carolina Criminal Justice Education &
Training Standards Commission from any civil or criminal liability whatsoever for
seeking such requested information and for evaluating such information as it relates
to my application for certification. And, I hereby release the issuing agency and its
agents and employees, both individually and collectively, from any and all liability for
damages of whatever kind, which may at any time result because of compliance with
this authorization and request.
I further waive all right to inspect or review any information compiled in reference
to my application for certification as allowed by law. I do further authorize the North
Carolina Criminal Justice Education & Training Standards Commission, its agents
and employees, to release copies of any and all information to any agency or entity
regulating the certification, authority or conduct of law enforcement officers. This is
Revised: 03/28/2017
Authorization for Release of Information
To North Carolina Criminal Justice Education
& Training Standards Commission
To Whom It May Concern:
I am an applicant for criminal justice officer certification or a certified officer with
the North Carolina Criminal Justice Education & Training Standards Commission.
In order to determine my suitability for certification or continued certification, I
understand that the North Carolina Criminal Justice Education & Training
Standards Commission must make a thorough investigation of my personal records
and personal background. It is in the public’s interest that all relevant information
concerning my personal and employment history be disclosed to the above agency.
Therefore, I, _______________________________________, DOB, _____________,
Operators License #____________________________, do hereby and authorize any
bank, credit union, lending or financial institution, credit bureau, consumer report
agency, retail business establishment, former and present employer, educational
institution, doctor or other health care professional including mental health, alcohol
treatment center, hospital or other repository of medical records, insurance company,
governmental agency, criminal or civilian courts, certification/licensing commission,
military organization, National Personnel Records Center, Air Force Personnel
Center, Air Reserve Personnel Center, Coast Guard Personnel Center, Marine Corps
Manpower Management Records & Performance, Marine Forces Reserve, Army
Human Resources Command, Navy Personnel Command, Department of Veterans
Affairs, Division of Commissioned Corps Officer Support, and any other individual
agency to produce and provide copies of any and all information to the North
Carolina Criminal Justice Education & Training Standards Commission regarding
me, whether of a privileged or confidential nature.
Moreover, I hereby release the North Carolina Criminal Justice Education &
Training Standards Commission from any civil or criminal liability whatsoever for
seeking such requested information and for evaluating such information as it relates
to my application for certification. And, I hereby release the issuing agency and its
agents and employees, both individually and collectively, from any and all liability for
damages of whatever kind, which may at any time result because of compliance with
this authorization and request.
I further waive all right to inspect or review any information compiled in reference
to my application for certification as allowed by law. I do further authorize the North
Carolina Criminal Justice Education & Training Standards Commission, its agents
and employees, to release copies of any and all information to any agency or entity
regulating the certification, authority or conduct of law enforcement officers. This is
to include, but not limited to: North Carolina Criminal Justice Education & Training
Standards Commission, North Carolina Sheriffs’ Education & Training Standards
Commission, North Carolina Attorney General’s Office, agencies of other states and
the federal government, and the applicant’s/officer’s employing agency.
I hereby acknowledge that this authorization is valid for (1) year or until the
employment application or investigative process has been completed, whichever is
later.
A copy of this document is considered valid, just as the original.
I have read and fully understand the above statements.
______________________________
Applicant Signature
____________________________________
Printed Name
Address____________________________
____________________________________
____________________________________
____________________________________
Phone Number:______________________
Date:_______________________________
STATE OF NORTH CAROLINA
COUNTY OF _________________
Subscribed and sworn to before me,
this is the ___ day of ___________, 20_____.
_______________________________________
Notary Public & Seal
My Commission Expires: __________________
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