I verify that the statements made in this application are true and correct. I understand that any false statements herein are made subject to penalties of 18 PA.C.S. 4904, relating to unsworn falsification of authorities. I consent to and authorize, without reservation, the City of Reading to obtain information relating to my law enforcement record, convictions for other than Summary Offenses, my tax payment record (including all applicable taxes payable to the city of Reading), and my utility payment records. Convictions or tax deliquincies will not automatically disqualify the applicant. I authorize each applicable agency to which this form is presented to release any results, upon request of the City of Reading, as described above. Copies of this consent that show my signature are as valid as the original signed by me. This consent is valid until the termination of my application process or my affiliation with the City of Reading, whichever is later.
I hereby irrevocably release and discharge each agency to which this form is presented and such agency’s representatives and agents from any and all liability of any nature whatsoever in any way arising from or relating to disclosure of information of any nature about me and I further agree to indemnify and hold harmless each such agency from any and all loss, cost, damage, expense, or liability of any nature (including, but not limited to, attorney fees and criminal penalties) incurred by such agency or its representatives and agents in association with, or as a result of disclosure of information about, me. I further agree each agency to which this form is presented and such agency’s representatives and agents are third-party beneficiaries with direct standing to enforce the release and indemnification provisions set forth herein.