Authorization To Release Information

Authorization to Release Information From: To: I have applied for a position with: I have been requested to provide information for the above-named party's use in reviewing my background and qualifications. Therefore, I authorize the investigation of my past and present work, character, education, military and employment qualifications. The release in any manner of all information by you is authorized whether such information is of record or not, and I do hereby release all persons, agencies, firms, companies, etc., from any damages resulting from providing such information. This authorization is valid for 90 days from the date of my signature below. Please keep this copy of my release request for your tiles. Thank you for your cooperation. Signature: Witness: Date: Date: Medical information is often protected by state and civil codes. Consult your attorney if you wish to seek this information. Note: Many employers are reluctant to provide information on previous employees. If you ask each prospective employee to distribute this form to his or her references before you contact them, the prior employers may be more willing to release information. American LegalNet, Inc. www.FormsWorkFlow.com 2001 © American LegalNet, Inc.