Employee Information Release Form

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

	www.PrintableContracts.com