CANDIDATE MEDIA RELEASE
I acknowledge that by engaging with Skills for Chicagoland’s Future from the below date and beyond, I may be the subject of various media (e.g., motion picture, audio recording, still or video device photography) which may be used by Skills for Chicagoland’s Future in connection with the distribution, advertising, publicity or promotion and/or other exploitation of Skills for Chicagoland’s Future. I hereby consent to the creation of such media and to such usage of this media, and further grant to Skills for Chicagoland’s Future the unrestricted right to use, publish, and/or reproduce any and all such media.
I hereby waive any and all rights to privacy and publicity with respect to such media and hereby waive any right that you may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied. I further release and forever discharge Skills for Chicagoland’s Future, their successors, affiliates, licensees, assigns, agents and legal representatives from any and all claims and liability related to or arising from the rights granted above to Skills for Chicagoland’s Future.
EMPLOYMENT DATA CONSENT AUTHORIZATION FORM
By checking the box below, I authorize Skills for Chicagoland’s Future and the State of Illinois, including the Illinois Department of Employment Security (IDES), to release a copy of the following records pertaining to my demographic and Unemployment Insurance (UI) information:
• Total dollar amount of wages by quarter as reported by my former employers for the last three completed quarters.
• Beginning and ending dates of most recent valid UI claim and claim award (weekly and maximum benefit amount), claim balance, and whether I have exhausted my benefits.
• Last employer name and address, last date worked, and whether laid off due to lack of work.
• Any demographic information provided above will be used anonymously and in aggregate.
I authorize the Workforce Innovation and Opportunity Act (WIOA) entity and Skills to use my IDES information for purposes related to my eligibility under the WIOA, Public Law 113-128, for the Dislocated Worker Program and other WIOA services or programs. This Authorization shall remain from the date completed.
I also authorize Skills for Chicagoland’s Future and/or their contracted representatives to solicit relevant information from my employer regarding my previous, current, and/or future employment status.
I certify that the information completed above is accurate to the best of my knowledge and agree to the statements listed above.
CONFIDENTIALITY NOTICE: I certify that the information listed above is accurate and true to the best of my knowledge. The disclosure of your social security number is voluntary. However, since most IDES records are filed by social security number, IDES may be unable to locate any or all records requested without it. This notice is for the sole use of the intended recipients. It contains confidential information. Under Penal Code 502 and Civil Code 1798.53 any review, use, disclosure, or distribution of the content of this document is prohibited and subject to criminal penalties/fines. If you are not the intended recipient of document please return it to the originating agency.