BONNEVILLE COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER
3/29/2004 N:\Forms\SheriffApplForm.docx 8 of 9
605 N. CAPITAL AVE., IDAHO FALLS, ID 83402
AUTHORIZATION FOR RELEASE OF INFORMATION
I the undersigned, hereby authorize Bonneville County to investigate any and all information which may
be necessary to determine my qualifications for employment including records subject to the Privacy
Act of 1974 (Public Law 93-579).
I understand that this investigation may include employment, education, driving, military, medical,
credit, police, civil and criminal records. I also understand that I have a right to make a written request
within a reasonable time to receive information about the nature and scope of such investigation.
The release of any and all factual information is authorized whether of record or not and I do hereby
release all persons, organizations, firms, agencies, companies or groups from any damages resulting
from furnishing such information to Bonneville County. I also agree that a copy of this release shall
function as an original.
NAME:____________________________________ Soc. Sec. No. _____________________
(Print or Type)
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