Pre-Employment Authorization And Release Form printable pdf download

Reference Checking: Pre-Employment Authorization and Release

PRE-EMPLOYMENT AUTHORIZATION AND RELEASE

All information provided by me in support of my application for employment is true and correct to the best of my

knowledge. I understand that misrepresentations or omissions may be cause for rejection or may be cause for

subsequent dismissal if I am hired.

I voluntarily and knowingly authorize any former employer, person, firm, corporation, organization, school, or government

agency, its officers, employees and agents, to release all information concerning my former employment, to this

prospective employer, its officers, employees and agents, or any other person or entity making a written oral request for

such information on behalf of this company.

I understand that the employment information may include, but is not

necessarily limited to performance evaluations and reports, job descriptions, disciplinary reports, letters of reprimand,

opinions, and public record information regarding my suitability for employment possessed by it. I recognize that a copy

of this authorization and release is as valid as the original and should be considered as such.

I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless such former employer,

person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims,

liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or

unknown, anticipated or unanticipated, arising from or incident to the disclosure or release except for the malicious and

willful disclosure of derogatory facts concerning my employment made for the express purpose of preventing me from

obtaining employment which the officer, employee or agent disclosing such facts knows are untrue.

Candidate's Signature

Date

Witness' Signature

Date

Print Candidate's Name

For reference checking purposes only, complete the following information

: (please print)

1) May your CURRENT supervisor, and/or any references or individuals associated with your CURRENT employer

(including Human Resource department) be contacted?

Yes

No Specific Comments:

2) Provide Social Security Number, required to obtain academic verifications:

3) Provide any FORMER or ALTERNATE NAME(S) such as change of last name, and/or use of assumed last name or

nickname in order to locate your employment and/or school records.

4) Provide NAME, CITY & STATE, ALL phone numbers AND dates of attendance OR graduation from:

High School

Technical School

College

Other

5) Note: Answer this question ONLY if instructed by the hiring employer. This information is required to conduct a criminal

record check. Date of Birth:

6) Note: Answer this question ONLY if instructed by the hiring employer. This information is required to conduct a driver’s

license check. Driver’s License Number:

State:

Releaseform.doc

4/01

Pre-Employment Authorization And Release Form

Related Articles

Related forms

Related Categories