Authorization To Obtain Employment And Reference Information And/or Review Personnel File Of Employment Applicant (Page 2 of 2) in pdf

To protect prospective employer’s when attempting to gain information in order to make their decision to hire

prospective employee.

Verification of Past Employers’ Rights when Providing Reference

I, ______________________________, understand that former employers, coworkers,

and/or educators are protected when providing a reference for my future employment,

and thus I have no basis for suit unless the statement is defamatory.

When providing a reference for an individual:

Pursuant to California Civil Code section 47 the communication is

qualifiedly privileged and thus a lawsuit is improper, absent a showing of malice;

An employer, coworker and/or educator has no duty upon an individual to

recommend anyone for employment; and;

An employer, coworker and/or educator may properly respond to an

inquiry from a potential employer concerning an individual’s fitness for employment.

In signing below, I understand the rights any employer, coworker and/or educator has

when providing a reference for my ability to work.

Name of Applicant: ______________________________________________________

Social Security Number (current civil service employees only): _______-_____-_______

I hereby authorize any employer, coworker and/or educator to provide a reference based

on their knowledge of my ability to perform work.

_________________________________________________

________________

Applicant’s Signature

Date

_________________________________________________

________________

Signature of Individual(s) obtaining and reviewing information

Date

PRIVACY STATEMENT

This information is requested by the State of California. The Information Practices Act of 1977 (California

Civil Code Section 1798.17) and the Federal Privacy Act (5 USC 552a, subdivision (e)(3); require this notice

be provided when collecting personal information from individuals. Information requested on this form,

which includes the social security number is needed by human resource staff to identify applicants

accurately. Furnishing the requested information on this form is mandatory. Failure to provide this

information will prevent the hiring division/unit from obtaining crucial information needed during the hiring

process, and will affect the potential employee’s chances for hire.

Purpose

To provide employers, coworker and/or educators of their rights when providing information to prospective

employers of an individual’s ability to work. This information is protected under California Civil Code

section 47 as qualifiedly privileged. However, any information given with malice will not be protected. An

employer has no duty to give information at any time.

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