Mukwonago Police Department - Authorization for Release of Information
To Whom It May Concern:
I am an applicant for a position within the Village of Mukwonago, Wisconsin, Police Department. I realize that during the processing of my application, I will be investigated by personnel officers of that department.
I hereby empower an employee of the Village of Mukwonago Police Department or other authorized representative bearing this release to, within one year of its date, obtain information and records pertaining to me from any and all of the following sources:
- Municipal, State or Federal law enforcement agencies.
- Selective Service system.
- Any banking information.
- Any place of business (for purposes of obtaining credit or employment data.)
- Credit rating bureaus or institutions maintaining individual credit rating files.
- Any previous employer.
- Present employer(s).
- Any school, college, university or other educational institution.
- Any office, clinic, sanatorium or hospital where illnesses, injuries and/or deterioration (physical and/or mental in nature) are diagnosed and treated.
I hereby release any Municipal, State, or Federal law enforcement agency, individual or institution, including its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information or any attempt to comply with it
I understand that any information concerning my past will be considered in evaluating me as an applicant to the Village of Mukwonago, and that all information obtained by the Village of Mukwonago in conjunction with this investigation and this permission, is confidential and I have no right to examine it, as the people contacted will be advised that what they say will be held in confidence.