аЯрЁБс>ўџ /1ўџџџ.џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС!` №ПШbjbj\­\­ C>Ч>ЧШџџџџџџЄЄЄЄЄЄЄЄИММММ ШИ ЖшшшшшшшшŽ       $Х h- ЖД ЄЬшшЬЬД ЄЄшшЩ Z Z Z ЬЄшЄшŽ Z ЬŽ Z Z ЄЄZ шм BчŠ ЧМт"Z Ž п 0 Z у  @у Z у ЄZ 4ш" Z "6–шшшД Д D шшш ЬЬЬЬИИИМИИИМИИИЄЄЄЄЄЄџџџџ AUTHORIZATION FOR THE RELEASE OF PRIVATE PERSONNEL DATA UNDER THE MINNESOTA GOVERNMENT DATA PRACTICES ACT TO WHOM IT MAY CONCERN: I, ______________________________________, hereby authorize (name of institution) _______________________________________ to release the personnel records described below about me to: ____________________________________________ ____________________________________________________________________ ____________________________________________________________________. The specific records covered by this release are: _______________________ ____________________________________________________________________ ____________________________________________________________________. The persons to whom the information may be released, and their representatives, may use this information for the following purposes: _________________________ ____________________________________________________________________ ____________________________________________________________________. I understand that the personnel data listed above includes data which is classified as private personnel data on me under Minn. Stat. Ї 13.43. I understand that by signing this Informed Consent Form, I am authorizing the College/University to release to the person(s) named and their representatives data which would otherwise be private and accessible only to me and to the department. I understand that without my informed consent, the College/University could not release that data in my personnel files and records which is classified as private under Minn. Stat. Ї 13.43. I understand that when my personnel files and records are released to the person(s) named and their representatives, the College/University has no control over the use the person(s) named or their representatives make of the data disclosed. This consent expires upon completion of the above stated purpose or after one year, whichever comes first. However, if the above-described purpose is not fulfilled after one year, I may renew this consent. I am giving this consent freely and voluntarily and I understand the consequences of my giving this consent. Dated: _________________________________ Signed: ________________________________ ()jld i Љ Ў ю ѓ ; @  † Ц Ь Э ?ЦЧШѓчѓтокококококококжЯЧh f_h f_5 h f_h f_hФЅhZ-dh f_ h f_5h f_h#ж5CJaJh f_h f_5CJaJ)Wjkl„…j Џ ѕ і B ‡ Э Ю n Г љ њ ?@23rsœїїїїїђђђђђђђђђђђђђђђђђђђђђђђgd f_$a$gd f_ШўœЦЧШњњњњgd f_A 0PP&P1F:pЊ'оАа/ Ар=!А"А# $ %ААаАа а†œ@@ёџ@ NormalCJ_HaJmH sH tH DAђџЁD Default Paragraph FontRiѓџГR  Table Normalі4ж l4жaі (kєџС(No ListШџџџџ)Wjkl„…jЏѕіB‡ЭЮnГљњ?@23rsœЦЧЪ˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€Ш œШ Ш џџќyЋмЙ!§yЋьТBBЪKKЪ9*€urn:schemas-microsoft-com:office:smarttags€State€9*€urn:schemas-microsoft-com:office:smarttags€place€ ˆЮэЅХЪ'ЦЪ3жз]iЉЎЏЦЧЪЅХЪх