ISSUED JULY 1, 2021 AUTHORIZATION TO RELEASE

ISSUED JULY 1, 2021

AUTHORIZATION TO RELEASE INFORMATION

As an applicant for the position of _________________________ with the University of California, Davis

(the University), I am required to furnish information for use in determining my qualifications. For this purpose,

I authorize the release of information (described below) requested by the University concerning any

substantiated allegations of misconduct (and clinical care if applicable) to permit the University to evaluate such

information with respect to the teaching, research, and service criteria for appointment. I understand the

University will not request information authorized by this release unless I am a finalist for an academic

appointment with tenure or security of employment. This signed form authorizes my current or prior

institution(s) where I have been employed to share that information with the University.

For purposes of this Authorization, “misconduct” includes any violation of the policies governing employee

conduct at my current or former institutions where I have been employed. “Misconduct” includes, but is not

limited to, violations of policies prohibiting sexual harassment, sexual assault, and/or other forms of harassment

or discrimination. “Substantiated allegations” means allegations that have been sustained based upon a

standard of evidence of at least a preponderance of the evidence.

The University considers sexual misconduct and other forms of harassment or discrimination

with students or

trainees to be related to teaching; with staff or colleagues to be related to service; and (if applicable) with

patients to be related to clinical care. This authorization includes release of information of a confidential or

privileged nature, or any data or materials which have been sealed or agreed to be withheld pursuant to any

prior agreement or court proceeding involving disciplinary matters. Should an institution provide information

on a finding of misconduct, I will be informed and allowed to provide information in response.

I hereby release, discharge, and exonerate (1) the University, its agents and representatives and (2) any

institution or employer where I am currently, or have in the past been, employed, or any individual acting

on behalf of such institution or employer, furnishing information to the University, from any and all liability

of every nature and kind arising out of the furnishing and inspection of such documents, records and other

information. This release shall be binding on my legal representatives and successors.

This authorization is valid for 365 days from the date of signature. A photocopy of this release is to be

considered as valid as an original.

Print Name

______________________________________

Signature Date

Sexual Misconduct includes conduct prohibited by the University of California Sexual Violence and Sexual Harassment

Policy including sexual assault, domestic violence, dating violence, stalking and sexual harassment. In addition, the UC

Faculty Code of Conduct prohibits entering into a romantic or sexual relationship with any student for whom a faculty

member has, or should reasonably expect to have in the future, academic responsibility (instructional, evaluative, or

supervisory). The UC Faculty Code of Conduct also prohibits exercising academic responsibility (instructional, evaluative,

or supervisory) for any student with whom a faculty member has a romantic or sexual relationship. The UC Faculty Code

of Conduct outlines in further detail the types of conduct unacceptable of its faculty and other academic appointees.

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(title)