WP E-Signature by Approve Me - Sign Documents Using WordPress -

File Release Form

I, , give my consent for the Lo-Se-Ca Foundation to release information whether verbal or written from my human resource file to the following people and/or agencies for the following reasons:

Please initial beside the areas that you choose.

Job related reference check

Financial institutions requesting information

Other agencies requesting proof of training certification

Educational institutions requesting a reference check

Lo-Se-Ca Staff phone list (circulated to all programs)

I understand that information will not be released unless it is specified as above or other written consent has been obtained. This consent will be reviewed annually and may be changed or revoked at any time by the employee with written notice.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Timestamp

Audit

October 4, 2018 2:39 pm MDT

File Release Form Uploaded by Rebecca McLeod - RMcleod@loseca.ca IP 207.228.70.195