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MILLER MENDEL, INC. Schedule 2.3.3.1 Approved Minor Release Agreement PROPRIETARY AND CONFIDENTIAL This release is provided as a general guide for Client to draft their own desired release. All final Minor Release Agreements must be approved prior to use, by MMI. , understand that in connection with the application process, that the Print your name (Agency Name) may request information from my past employers and/or references, and I also understand that such investigation may include a review of any criminal records. I certify that I have provided complete and truthful information to the (Agency Name) regarding all sources of information concerning my past employment, education, certification and criminal conviction record, as well as any other information requested in my employment application, and have been fully informed that any misrepresentations or material omissions concerning such information will be grounds for denying my application, withdrawing any offer of appointment or immediate discharge. In order to assist the (Agency Name) in obtaining documents and information to confirm my background, I hereby consent to the release of the information as described below. I request, authorize and consent to the release of information to the (Agency Name) regarding my previous and current employment, and authorize all employers or agents that they may designate, to respond forthrightly to verbal or written inquiries from the (Agency Name) regarding my employment record, including but not limited to: positions held, dates of employment, beginning and end pay rates; work performance; disciplinary records, reliability and any incidents of dishonesty; insubordination, violence and/or unsafe behavior; harmful or threatening behavior, including information based upon materials in my personnel files. Further, I direct you to release such information upon request of any duly accredited representative of the (Agency Name), regardless of any agreement, instructions or representations I may have made with your previously to the contrary. I further request, authorize and consent to the (Agency Name) investigation of whether I have a record of criminal convictions, and if so, the nature of such criminal convictions and all surrounding circumstances available through lawful means. The (Agency Name) has advised me that any criminal background check will focus on convictions, and that a conviction as such will not necessarily disqualify me from appointment. I also waive any and all rights and claims I may have against the (Agency Name), its employees, representatives or agents, Miller Mendel, Inc., former educational institutions, or any person listed as a reference, from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure or release of such information by any person or party, whether such information is favorable or unfavorable to me. It is with full understanding and consent that I agree that a photocopy of this authorization may be used only for the purposes stated above. Participant Signature: Parent(s)/Guardian(s) Signature: Parent(s)/Guardian(s) Signature: Date: Date: Date: If the Participant is under 18 years of age or legally incapacitated, both parent(s)/guardian(s) must sign. To be completed by Applicant in the presence of the Notary Public: (Notary requirements per each state go here) MASTER SOFTWARE LICENSE & SERVICES AGREEMENT PAGE 18 OF 18 Version: August 27, 2015 — Santa Ana PD Only