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Job Application - CONFIDENTIAL Release Form

Palmetto Breeze Transit/Lowcountry Regional Transportation Authority

P.O. Box 2029

25 Benton Field Road

Bluffton, SC 29910

Phone: 843-757-5782     Fax: 843-757-5783

Email: jbonner@palmettobreezetransit.com

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To: Background Check Provider and S.C. Department of Transportation

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I hereby authorize the Lowcountry Regional Transportation Authority DBA Palmetto Breeze Transit to receive any criminal history and motor vehicle information pertaining to ,e, which may be in the files of any state or criminal justice agency using a nationwide database search.

 (If you have a touch screen, sign with your finger. If not, hold down the left mouse button and sign your name.)

Thank you for submitting! Please complete the Voluntary Survey below to assist us with our Affirmative Action program.

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