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.

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Signature Certificate
Document name: File Release Form
lock iconUnique Document ID: a83e1241753f88226f848f65b5df0caf8a19d8f7
Timestamp Audit
October 4, 2018 2:39 pm MDTFile Release Form Uploaded by Rebecca McLeod - IP