Indiana Applicant Information Release


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                             This Applicant Information Release form is used by an employer for the purpose of eliciting
                             information about an applicant from former employers, educational institutions, and
                             personal references listed by the applicant in the application for employment. This form is
                             useful for employers located in Indiana when checking references supplied by potential
                             employees. Many references will ask for a release before providing information, in order to
                             protect themselves from any potential liability that may arise from disclosing information
                             regarding the applicant. This release notifies the references that the applicant has
                             consented to the release of such information.

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                         APPLICANT INFORMATION RELEASE

This Agreement is made and effective on this ____ [Month] ____ [Date], 20____, by and
between _____________________________ [Instruction: Insert the name of employee],
located at __________________________________________ [Instruction: Insert the address
of the employee] ("Employee") and _____________________________ [Instruction: Insert
the name of company], with a place of business at _______________________________
[Instruction: Insert the address of the company] ("Company ").

In connection with my application for employment with the Company, I hereby agree as

I hereby authorize any person, educational institution, or company I have listed as a reference on
my employment application to disclose in good faith any information they may have regarding
my qualifications and fitness for employment. I will hold __________ [Instruction: Insert the
name of company], any former employers, educational institutions, and any other persons
giving references free of liability for the exchange of this information and any other reasonable
and necessary information incident to the employment process.

For: EMPLOYEE                                      For: COMPANY

Signed:_________________________________ Signed:_______________________________

Name:                                              Name:

Date:                                              Date:

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