1. This form should be put on your company's letterhead.

2.Get a separate form signed for each employer you intend to check with. Employers are much more likely to release information when they have a form signed by the applicant specifically authorizing them to do so.

AUTHORIZATION FOR PRIOR EMPLOYER TO RELEASE INFORMATION

(Please read the following statements, sign below, and return to the Human Resources office.)

          (Applicant's name below)

I, ___________________________, hereby authorize my prior employer, ____________________________________, to release any and all

information relating to my employment with them to ___________________________________ (your company's name). I further release and

hold harmless both ________________________________and __________________________________ (your company's name) from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employer will be held in strictest confidence, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will not have the right to see the information.

__________________________________  __________________

Applicants Signature                                          Date

__________________________________

Print Employee's Name

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