ReleaseForm.doc - DEPARTMENT OF MENTAL HEALTH AND ADDICTION...

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DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES Human Resource Services Center/Employment Services Division Shaping a quality, diverse workforce through competence, commitment, and pride. RELEASE OF PERSONNEL/PAYROLL AND EDUCATIONAL INFORMATION Applicant Name: Position Applying For: Position Number: I. RELEASE OF INFORMATION AUTHORIZATION – PAYROLL/PERSONNEL I do hereby authorize the release of payroll/personnel information from my present and previous employers to the Department of Mental Health and Addiction Services Human Resource Services Center/Employment Services Division. This will include information concerning my wages, attendance records, human resource information or any other related information. I understand that this information will be used for pre-employment evaluation purposes.
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