Fill and Sign the Can Employers Give a Bad Reference for a Former Employee

Basic form © James R. McDade (ver 02-21-01) 209-667-2300 EMPLOYMENT REFERENCE FORM Employers use this form when providing references on former employees. (Delete this note prior to use.) LIMITED REFERENCE INFORMATION Employer’s Name: ____________________________________________________________Employee’s Name: ____________________________________________________________Date of Hire: ___________________ Date Employment Ended: ______________________Positions Held: _______________________________________________________________Last Pay Rate: ___________________Duties of Last Position: _________________________________________________________ ____________________________________________________________________________UNLESS THE CURRENT OR EX-EMPLOYEE HAS SIGNED AND RETURNED THE WAIVER AND HOLD HARMLESS AGREEMENT BELOW, NO FURTHER INFORMATION WILL BE PROVIDED ABOVE EXCEPT TO CONFIRM THAT THE ABOVE INFORMATION IS ACCURATE ACCORDING TO THE COMPANY’S RECORDS. AUTHORIZATION FOR FULL EMPLOYMENT REFERENCE AND WAIVER AND HOLD HARMLESS AGREEMENT The undersigned current or former employee hereby authorizes ________________ ________________________________________ (hereinafter, the Company”) to release to _________________________________________ any information about the undersigned’s job title, duties, rate of pay, dates of employment, and any other information relating to job performance at the Company which may be requested.In consideration of the Company cooperating in providing this information, the undersigned hereby waives, releases, and agrees to defend and hold the Company, its owners, officers, directors, employees, and representatives harmless from any and all claims relating to or arising from any information released by the Company.This waiver shall remain in full force and effect until revoked by the undersigned in a writing delivered to the Company, which revocation shall only apply to inquiries received by the Company after the revocation is effective. __________________________________ ____________________________Current or Former Employee's Signature Date