AUTHORIZATION FOR RELEASE OF INFORMATION

I, _______________________________________, hereby authorize any Investigator or duly accredited representative of the City of _______________, Texas, to obtain any information from schools, residential management agents, employers, criminal justice agencies, or individuals, relating to my activities. This information may include, but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information upon request of the bearer. I understand that the information released is for official use by the City and may be disclosed to such third parties as necessary in the fulfillment of official responsibilities. I direct you to release such information upon request of the duly accredited representative of any authorized agency regardless of any agreement I may have previously made with you to the contrary. I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me on account of compliance, or any attempts to comply, with this authorization. A copy of this authorization shall be as effective as the original.
SIGNED this _________ day of __________________________, _________.

__________________________________________

WITNESS:

___________________________________

The foregoing language has been held to release all claims against former employers for furnishing information in response to inquiries. Smith v. Holley, 827 S.W.2d 433 (Tex. App.-San Antonio 1992, writ denied); Cox v. Nasche, 70 F.3d 1030 (Ct. App. Alaska [9th Dist.] 1995).

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