LPD new phs 10/2018 Initial this page to indicate that you have provided complete and accurate information:_______
LINDALE POLICE DEPARTMENT
105 BALLARD DRIVE LINDALE, TX 75771 PH. 903-882-3313 FAX 903-882-1054
AUTHORIZATION RELEASE OF INFORMATION
This release, when presented by a duly authorized representative of the Lindale Police Department, constitutes my consent
and authority to examine and obtain copies and abstracts of records and to receive statements and information regarding my
background. This includes whether the records are public, private or confidential. THIS AUTHORIZATION DOES NOT
INCLUDE ANY MEDICALLY RELATED HISTORY OR WORKER’S COMPENSATION CLAIMS.
Specifically, I authorize the release of the following data or records to the Lindale Police Department: Employment and Pre-
employment records; including background reports, efficiency ratings, complaints or grievances filed by or against me,
records of recollections of attorneys at law or other counsel, whether representing me or another person in any case, either
civil or criminal, in which I presently have, or have had an interest, excluding any medical malpractice cases or worker’s
compensation claims. Also included are Educational records, Selective Service, Police and Criminal, Motor vehicle and
Driving, Financial and Credit, and Polygraph Examinations.
This authorization is given in connection with a background investigation being conducted relative to my application for or
continued employment with the Lindale Police Department. The intent of this authorization is to provide full and free access
to the background and history of my personal life, for the specific purpose of pursuing an investigation, which may provide
pertinent data for the Lindale Police Department, to consider my suitability for employment.
I understand that any information obtained by a personal history background investigation, which is developed directly or
indirectly, in whole or in part upon this release authorization, will be considered in determining my suitability for
employment by the Lindale Police Department. I understand that all materials pertaining to this background investigation
become the property of the Lindale Police Department and will not be returned to me.
I agree to indemnify and hold harmless the person to whom this request is presented and his/her agents and employees, from
and against all claims, damages, losses and expenses, including reasonable attorney’s fees, arising out of or by reason of
complying with this request. I further understand that in the event my application is disapproved, the confidential
information or source(s) of information will not be revealed to me.
A photocopy of this release form will be valid as an original hereof, even though the said photocopy does not contain an
original writing of my signature.
MUST BE SIGNED IN THE PRESENCE OF A NOTARY:
State of ________________________________:
Subscribed and sworn before me this ______________ day of _____________, 20______.
My commission expires _______________________, (Signature of Notary)_____________________________________.
City, State, Zip Code_______________________________