Consent to Release Form

In consideration of the need for SIPS Consults, Corporation (“Company”) to evaluate my suitability for placement as a prospective student, volunteer or employee, I hereby authorize the Company to retrieve information regarding my employment history, academic credentials, and criminal background, as allowed by law. Furthermore, the Company has permission to contact my references and other individuals that the Company, in its sole discretion, believes may have relevant information regarding my suitability for placement.
My signature below authorizes my former or current employers and references to release information regarding my employment record with their organizations and to provide any additional information that may be necessary, whether the information is positive or negative. This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a release or consent as the original which I sign.