AUTHORIZATION & CONSENT FOR RELEASE OF INFORMATION
I understand that in connection with the application process, the Nederland Fire Protection District
(“District”) may request information from my past employers, volunteer organizations, educational
institutions, and personal references, and that such investigation may include a review of any criminal
records and driving record. I have provided complete and truthful information to the District regarding all
sources of information about my past employment/volunteer service, education, licensure, as well as any information requested in the employment application, and have
been fully informed that any misrepresentations or material omissions concerning such information will
be grounds for denying my application, withdrawing any offer of employment, or immediate
discharge. In order to assist the District in obtaining documents and information regarding my
background, I hereby consent to the release of the following information: