Release Authorization Agreement

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									This is an agreement between a prospective employee and an employer where the
applicant agrees to authorize the employer to contact the candidate’s references and
former employers. The candidate releases the employer, the references, and former
employers from any claims related to the authorization. Employers and their human
resources departments should use this from when interviewing job applicants and
should have the candidate sign this document prior to contacting any of the candidate’s
references. This template document can be customized to fit the needs of any

This applicant information release authorization agreement (the “Agreement”) is effective as of
the    ___ day of ______________, 20___ [Instruction: Insert Date] (the “Effective Date”),
by and between ___________________ [Instruction: Insert Name of Company],
_______________________ [Instruction: Insert Address] (the “Company”), and
____________________ [Instruction: Insert Name of Employee], ______________
[Instruction: Insert Address] (the “Applicant”).

WHEREAS, Applicant has applied for a position with Company;

WHEREAS, Company wishes to contact the personal references, professional references,
educational institutions, or other companies that Applicant has listed on Applicant’s employment
application, resume or curriculum vitae (individually and collectively, the “References”) to
verify information incident to the potential hiring of the Applicant, all in accordance with
Company’s reasonable employee background check procedure and screening process;

WHEREAS, Applicant wishes to grant Company such permission;

NOW, THEREFORE, in connection with Applicant’s application for employment with the
Company, Applicant hereby agrees as follows:

1. Applicant hereby authorizes the References, to disclose to Company, in good faith, any
information they may have regarding the qualifications and fitness for employment of the

2. Applicant shall hold harmless Company and References, and Company’s and Reference’s
respective officers, employees, or related personnel, from any and all liability for claims,
liabilities, causes of action, damages, judgments, attorneys’ fees, court costs, and expenses or
damages of whatever kind, related to the exchange of such information and any other reasonable
and necessary information disclosed to Company during the employment background check and
screening process.

3. By signing this Agreement, I affirm I have been fully advised of my rights and obligations
under applicable law and the Company’s policies.

____________________________ [Instruction: Insert Signature of Applicant]

___________________________ [Instruction: Insert Name of Applicant]

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