Authorization to Release Information

I hereby authorize the release of any and all information or documents maintained by Thomas Rest Haven and any of its employees or agents, which may be pertinent to any request of information of perspective employers. I specifically authorize that this Release of Information will include all documents or information relating to my past and present work, character, education, or references, including information covered by the Privacy Act of 1974.

I hereby release all persons, firms, agencies, companies, or other entities from any liability or damages which may result from furnishing the requested information.

This authorization is valid for six months from the date of my signaure below. A copy of the release has the same force as the original. You may retain a copy of the release forwarded to you for your files.

Thank you for your assistance.

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