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The following form may request personally identifiable or protected health information. Please see our Privacy Policy for details. This form is encrypted. SSL is on to ensure a higher level of security. A recaptcha must be completed before submission, you cannot save progress, and you cannot receive an email copy of the form.

Consent to Release Information

  1. The Workforce Solutions of West Central Texas Board (WSWCTB) considers information in customer records to be confidential. Release of information may be authorized for the sole purpose of delivering services under the programs offered by Workforce Solutions Center or WSWCTB. The lists below indicate the types of persons/entities with whom Workforce solutions will and will not exchange confidential information.
  2. Persons/Entities with whom confidential information may NOT be exchanged:
    Family members or any other individual person to whom you have not permitted Workforce Solutions to release your information (except in the case of youth customers under the age of 18, in which case Workforce Solutions will release information to parents/guardians), Any entity not otherwise permitted to obtain confidential information about you from Workforce Solutions.
  3. Persons/Entities with whom confidential information may be exchanged:
    Employers, Health-related agencies, Education/training agencies, Public service agencies, Governmental agencies, Other Workforce Solutions partners integral to providing services to you, Individuals specifically named in writing by you to whom you are permitting the release of your Workforce Solutions information (as indicated on the following lines).
  4. Signature Authorization
    My signature authorizes the release of information between these agencies/individuals and from outside parties related to the delivery of services to me. Furthermore, i release such persons and institutions, and Workforce Solutions/WSWCTB from any legal claims arising from the criminal background check process, if applicable for services.
  5. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that: your application will not be signed in the sense of a traditional paper document, by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, you may still be required to provide a traditional signature at a later date.
  6. For non-CCS customers under 18 years old
  7. Equal Opportunity Employer/Program
    Equal Opportunity Employer/Program. Auxiliary aids and services are available upon request to individuals with disabilities. Relay: 1-800-735-2989 (TTY) / 711 (Voice).
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