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Customer Registration

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General Release of Information

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.

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