I hereby release Saunders Staffing Inc., or Personnel Pool of Virginia, Inc., herein called (Companies) from all liability and hold harmless said Companies regarding the validity of my Professional License/Certification and Status.

I also authorize said Companies to confirm my License/Certification and Status with the stated certification entity.  I give such entity the right to release any and all documentation regarding my License/Certification and Status.

Entity:_____________________________________________

Adddress:_________________________________________

City/State/Zip_________________________________________

License #___________________________________________

License Status-Active__________In-Active_________Disciplined_______

Document Attached:  Yes_______No______

Signature:_______________________

Date:_____________________________

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Professional License Liability Release

SAUNDERS STAFFING INC.

PERSONNEL POOL OF  VA.   INC.

400 North Street Bluefield WV. 24701 Ph: 304-325-3369 Fax: 304-325-6817

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