AUTHORIZATION FOR RELEASE OF INFORMATION


The internship appointment process at the DOD and other federal facilities is administered by Oak Ridge Institute for Science and Education (ORISE) for Oak Ridge Associated Universities (ORAU) and includes, but is not limited to, the following: completion of Program application, interviews, reference checks, medical screening, employment and education verification, and as appropriate, a security background check will be initiated and completed as a condition of appointment, Although ORAU administers the program, it in no way conducts the security background checks. The background check is conducted by an appropriate investigative agency. Signing this authorization will facilitate your consideration for possible appointment.

I hereby authorize any person, agency, organization, or institution to release to DOD, other federal facilities and/or its representatives on a confidential basis information the sponsoring organization may request about me regardless of any agreement I may have made with you previously to the contrary. This information may include, but is not limited to academics, performance evaluation, employment history, attendance, character, credit history, and police records. I hereby release any person, agency organization, or institution, including DOD, other federal facilities, and ORAU, from any and all liability whatsoever resulting from this inquiry. The Privacy Act of Section 6311 of Title 5 to the U.S. Code protects any information received as a result of the investigation. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature.