Create - Authority to Release Personal Information

Authority to Release Personal Information

To: Colin Joss & Co Pty Ltd t/a Joss Facility Management

Full Name

Date of Birth

Street Address

Suburb

City

Postcode

State

Telephone No

I authorise and direct Colin Joss & Co Pty Ltd t/a Joss Facility Management (Joss Management) to provide to the New South Wales Government (including any NSW Government Departments or Agency) (Receiver) my name, address, telephone number, date of birth and email address (personal information) as set out above.

I understand my personal information will be provided to the Receiver so they can confirm my suitability to commence work as a Cleaner on the future contract between Joss and the New South Wales Government, including:

Working with Children Clearance check;
Australian State and Federal Police checks to determine my criminal history and whether I have any pending charges and/or trials

My Signoff:

My Name:

Signature