Sample Employee Authorization Form - Divorce Solutions, Llc printable pdf download

Sample Employee Authorization Form - Divorce Solutions, Llc

SAMPLE EMPLOYEE AUTHORIZATION FORM

I ___________________, authorize ____________________________ to

provide Attorney __________________ along with his/her associates with any

and all information they may request or require concerning my retirement

benefits (both qualified and non-qualified), other employment benefits,

employment history (including dates of employment and salary history), COBRA

continuation coverage, stock option agreements, signing contracts and bonus

and other incentive compensation plans.

This authorization will become invalid 365 days within receipt of this request.

To facilitate handling this matter, I authorize you to reveal this information by

phone, letter or fax to the above-noted authorized agents. In addition, I ask

that you honor faxed transmissions of this authorization form or copies thereof,

recognizing that the original will be forwarded, if requested for your records.

If there are any questions regarding this authorization, please contact me at:

__________________________________________

Employee’s Signature

__________________________________________

Employee’s Name (typed or printed)

_______________________________

Employee’s Social Security Number

_______________________________

Employee’s Phone

Date:___________________________

Sample Employee Authorization Form - Divorce Solutions, Llc