SECTION 1 – Applicant Information
Applicant Full Name:
Other Names Currently Used or Previously Used:
Current Home Address:
Current Phone Number:
SECTION 2 – Applicant Agreement
I have applied for a position that has been designated as “sensitive” with the Department of Forestry. This designation permits the agency to conduct a fingerprint-based criminal history check. Therefore, I hereby authorize any investigator or duly accredited representative of the Department of Forestry bearing this release, or a copy thereof, to obtain any information from law enforcement/criminal justice agencies and report the results of such search to the designated representative of the agency named above. I direct that such information be released upon request to the bearer of this form. I understand that the information released is for official use by the Virginia Department of Forestry. I submit to fingerprinting and understand that my fingerprints will be sent to the Virginia State Police for a criminal history check. I hereby release any individual, including records custodians, from any and all liability for damages of whatever kind or nature that may at any time result to me on account of compliance, or any attempt to comply, with this authorization. Should there be any questions as to the validity of this release, you may contact me as indicated below. I understand that any and all information collected pursuant to this background check may be used in assessing my suitability for the position for which I have applied. The information will not be shared with parties outside of the agency where the position is located. I further understand that I may challenge the results of the background investigation conducted by the Virginia State Police or the Federal Bureau of Investigation and may request information needed to make such a challenge from the Virginia Department of Forestry.
Applicant Name (Print)	Applicant Signature	Date