I hereby give my permission for Complete Technology Solutions staff to obtain and/or disclose my
past, present, and future information or records that may be needed for eligibility
determination, monitoring and follow-up purposes. This information may include, but
shall not be limited to employment information, assistance records, and assessment
or evaluation tools. A photocopy/facsimile of this signed consent form may be used
to obtain/release information authorized by signature on this form.
It is also my understanding that any information obtained by the above organization
will be held in strict confidence.
I understand that I may revoke this consent at any time by providing a written
statement to staff indicating that my consent to the release of information is no
longer given to the party(ies) previously granted permission.