I ______( Full Name) Give My Permission to Staffing Partners to Use My

I ______( full name) give my permission to Staffing Partners to use my:

Name ____ Yes ____No

Testimonial ____Yes ____No

Image/Photograph ____Yes ____No

In publications and advertisements produced by or for Staffing Partners

I understand that these publications will also be placed on web sites for public relations and advertising purposes.

I also give permission for Staffing partners to use the above information relating to me in any future publications and websites produced by or for Staffing Partners for public relations and advertising purposes.

_____ Yes _____No

My contact information is:

Name (where applicable) ______

Phone Number (not published) ______

Address (not published) ______

I understand that:

The publication will appear on the Internet/World Wide Web (WWW)

The publication will appear in print, electronic, or video media

The publication may enable readers to identify me

Important- please note:

I understand that if my person information (name, contact details, image) is published on the Internet/WWW then it will be accessible to users from all over the world.

My information can also be searched for using identifier such as my name, and may be copied and used by another person using the Internet/WWW.

Most importantly, I understand that once my personal information has been published on the internet/WWW Staffing Partners has no control over its subsequent use and disclosure.

Signature______Date______