Printable Contracts

   Employee Information Release

    

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Employee Information Release Form

Personal Information

Applicant Name: ______________________________

Date of Filing: ______________________________

Department: ______________________________

Position Title: ______________________________

Employment ID #: ______________________________

Type of Information to Release

Work History

Start and End Dates

Evaluations

Disciplinary Records

Benefits Information

Other: ______________________________

Authorized Personnel/Companies to Receive Aforementioned Information

Name #1: ______________________________

Address #1: ______________________________

Phone #1: ______________________________

Email Address: #1: ______________________________

Name #2: ______________________________

Address #2: ______________________________

Phone #2: ______________________________

Email Address: #2: ______________________________

I, the undersigned, do hereby swear that the aforementioned information is true and factual to the best of my knowledge. I authorize {Company/Contacts} to release the checked information to the aforementioned personnel.

______________________________
Applicant Signature

______________________________
Date Signed

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