Reference Checking Consent And Authorization Form printable pdf download

Reference Checking Consent And Authorization Form

University of Washington | Human Resources | UTemp Staffing Program

REFERENCE CHECKING CONSENT AND AUTHORIZATION FORM

Reference Checking Consent and Authorization Form

Disclosure

Please read the information on this form carefully and completely.

I have applied for employment with the University of Washington and have provided information about my

previous employment. I authorize the University of Washington to conduct a reference check with my present

and/or previous employer(s). I understand that reference information may include, but not be limited to, verbal

and written inquiries or information about my employment performance, professional demeanor, rehire

potential, dates of employment, salary and employment history.

My signature below authorizes my former or current employers and references to release information regarding

my employment record with their organizations and to provide any additional information that may be

necessary for my application for employment to the University of Washington, whether the information is

positive or negative. I knowingly and voluntarily release all former and current employers, references, and the

University of Washington from any and all liability arising from their giving or receiving information about my

employment history, my academic credentials or qualifications, and my suitability for employment with the

University of Washington.

I further authorize the University of Washington to obtain feedback and references from my supervisors over

the course of my employment with the University of Washington. I understand that subsequent and continued

employment with the University of Washington may be subject to this feedback.

This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a release

or consent as the original which I sign.

Name: __

Signature: ____________________________________

(please print)______________________________________

Date: _______________________

Cell Phone: __________________________________ Alternate Phone: __________________________________

Email Address: ________________________________________________________________________________

Revised: 1/2014

Reference Checking Consent And Authorization Form