AUTHORIZATION TO RELEASE INFORMATION
I have applied for a position with the following
As part of my application, I have been requested to
provide information concerning my background and qualifications. Therefore, I authorize the investigation of
my past and present work, character, education, military experience, and
employment qualifications by the above Company.
The release in any manner of any and all information
by you to the Company indicated above is authorized whether such information is
of record or not. I do hereby release
all persons, agencies, firms, companies, etc., from any responsibility for
damages resulting from their provision
of such information.
This authorization is valid for 90 days from the date
of my signature below. Please keep this
copy of my release for your files.
Thank you for your cooperation.
Signature: ___________________________ Date:
Witness: ____________________________ Date:
Medical information is
often protected by state laws and civil codes.
Consult your attorney if
you wish to seek this information.
Note: Many employers are reluctant to provide
information on previous employees. If
you ask each prospective employee to distribute this form to his or her
references before you contact them, the prior employers may be more willing to