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Employment Records Authorization - Kansas

Employment Records Authorization Form. This is a Kansas form and can be used in Civil 3rd Judicial District (Shawnee County) Local District Court .
 Fillable pdf Last Modified 7/20/2005
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EMPLOYMENT RECORDS AUTHORIZATION TO: The undersigned hereby authorizes you to forward to the law firm of________________________________________________________________________ ______________________________________________________________________________ ______any and all records, reports, or other information, to include wage veri fication, which theyrequest, concerning my employment with you, at the latter=s request and expense. Theundersigned further states that photostatic copies of this authorization shall have the full force andeffect of the original. Dated this _________ day of ______________________, 20______. ___________________________________ SIGNATURE Social Security No. _____ - ____ - ______ Date of Birth ____/_____/_____STATE OF ______________________ ) ) ss: COUNTY OF ____________________ ) On this ______ day of ____________________, 20_____, before me, a Notary Public inand for the county and state aforesaid, appeared _______________________ ________,personally known to me to be the same person who executed the above inst rument and dulyacknowledged the execution of the same. IN WITNESS WHEREOF, I have hereunto set my hand and seal on the date las t abovewritten. ____________________________________ Notary PublicMy Appointment Expires: __________________________
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