Reference Release Form - Oregon Military Department printable pdf download

Reference Release Form - Oregon Military Department

PERSONNEL POLICIES AND PROCEDURES

Attachment 2

OREGON MILITARY DEPARTMENT

AGP Policy 99.300.08

Reference Release Form

I understand that the Oregon Military Department will check references, as a part of the hiring

process, to learn about my work history. I understand that these references will be confidential

and disclosed only in accordance with ORS 192.410 through ORS 192.505. I also understand

that I will not have access to them. I release OMD and all providers of information from any

liability as a result of furnishing and receiving this information.

I give permission for a representative of the Oregon Military Department to contact my current

employer on my job application for a reference.

YES

I give permission for a representative of the Oregon Military Department to contact my past

employers as shown on my job application and any listed below for employment references.

YES

___________________________________

____________________________________

Printed Name

Signature

Date

Additional References to Contact:

Relationship:

Full Name:

Phone:

Company:

Address:

Relationship:

Full Name:

Phone:

Company:

Address:

Relationship:

Full Name:

Phone:

Company:

Address:

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Reference Release Form - Oregon Military Department