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Clerk of the Board of Supervisors

PO Box 827, Florence, AZ 85132


Application for Service on Pinal County Boards and Commissions

Home Address

Business Address


I hereby authorize Pinal County and/or its agents to make
investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information, which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment or appointment.

I hereby consent to Pinal County’s verification of all the information I have provided on my application form. I also agree to execute as a condition of employment or appointment or a condition of continued employment or appointment any additional written authorization necessary for Pinal County to obtain access to and copies or records pertaining to this information.



With regard to the foregoing disclosures, I hereby agree to release any person, or private or public entity from any and all causes of action that otherwise might arise from providing Pinal County with information it may request pursuant to this release and authorization form. I understand that any false information or
statements, or misrepresentation by omission, made by me on the application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsification or misrepresentation be discovered after I am employed.

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