Employee Authorization For Reference Letter
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1E
A
MPLOYEE
UTHORIZATION
F
R
L
OR
EFERENCE
ETTER
B
S
M
Y
UPERVISOR OR
ANAGER
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It is the policy of Umpqua Community College that all employment references be given by the
Human Resources Department. As a limited exception, managers and supervisors may be
allowed to provide letters of reference for current and former employees (not students) if this
form has been completed and approved by Human Resources in advance, along with a copy of
the proposed letter of reference. Providing a letter of reference without following this process
may be grounds for discipline of the person providing the reference.
Employee Authorization:
I authorize ____________________________________ to provide a letter of reference
(Please print)
regarding my employment at Umpqua Community College, including information on the
following topics (initial all that apply):
_____ Dates of employment
_____ Position(s) held
_____ Quality and quantity of work
_____ Punctuality
_____ Relationships with co-workers, supervisors, students, etc.
_____ Attitude toward work
_____ Reason for leaving
_____ Eligibility for rehire
_____ Compliance with policies and standards
_____ Performance strengths and weaknesses
_____ Other information regarding suitability for employment sought
I release the above named person, as well as Umpqua Community College, from any and all
claims or liability for providing the information I have authorized for release, as set forth above.
_________________________________________
_____________________________
Signature
Date
Print Name
Human Resources Authorization:
The attached proposed letter of reference has been approved.
_________________________________________
UCC Human Resources Representative
Date
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