This document, which should be signed by a job applicant, permits the applicant’s
previous employer to release information related to the applicant’s previous
employment. The employee grants permission to the previous employer to release
information about the employee to the potential new employer and releases the
previous employer from any liability from doing so. This form contains both standard
clauses and opportunities for the use of optional terms and conditions making it fully
customizable to fit the needs of the contracting parties.
RELEASE OF EMPLOYMENT INFORMATION
THE UNDERSIGNED _______________________ (the “Applicant”) hereby authorizes
[insert company name] (the “Company”) to release information about the Applicant in respect to
his/her employment with the Company to any prospective employer that may contact the
Company. The Applicant further authorizes the Company to disclose, to any prospective
employer any and all information pertaining to the Applicant’s job performance, hours worked
and description of duties and work performed by the Applicant. [Instruction: It is optional to
include a request to release information relating to rate of pay or salary]
The Applicant acknowledges that it is not the Company’s policy to disclose such
information, and Applicant’s execution of this release, hereby releases and forever discharges the
Company and any of its employees, officers, directors, affiliates and subsidiaries from any and
all liability which may arise in connection with the release by the Company of such information
to any prospective employer. This release shall include, but not be limited to, any and all claims
of libel, defamation, slander or negligence.
This release shall be effective from ____________________ to ____________________
and thereafter shall considered void and of no effective.
The Applicant has executed this release of his/her own free will and has read and fully
understands the terms, conditions and provisions contained herein.
DATED this ____ day of _______________, 2___.
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