Employee Personnel Records Release

EMPLOYEE PERSONNEL RECORDS RELEASE

This Employee Personnel Records Release authorizes the employer named below to disclose certain personnel records and employment information to the designated recipient for the purpose stated herein. Employee Name: Employee ID:

Personal Information

Position Information

Reporting Manager: Start Date: Current Salary:

Full-time Part-time Exempt Non-exempt

Recipient of Records

Expiration Date of Authorization: Revocable by Employee: (if checked, employee may revoke in writing)

Records to Be Released (check all that apply)

Complete personnel file (including hire and termination records) Performance evaluations and disciplinary records Compensation and payroll history Benefits enrollment and claims information Attendance, leave, and timekeeping records Training, certifications, and licensing records Investigation reports related to workplace incidents Other (describe below)

Authorization and Consent

I, the undersigned Employee, hereby authorize my current and former employer(s) and their agents to disclose the personnel records and information specified above to the recipient named in this form. This authorization includes the release of information relating to compensation, disciplinary matters, performance evaluations, attendance, benefits, and any other records expressly checked above. This authorization does not include the release of medical records or information protected under separate medical privacy laws unless expressly indicated in writing.

I understand that the information released pursuant to this authorization may be disclosed by the recipient and may no longer be protected by employer confidentiality policies. I release the Employer and its agents from any liability for lawful disclosure pursuant to this authorization and waive any claim for damages arising from such release, to the fullest extent permitted by law.

I further authorize the Employer to verify information contained in my personnel records and to provide truthful factual responses to inquiries from the recipient regarding my employment history and job performance. I authorize the recipient to obtain copies of the specified records for the purpose stated above.

I confirm that I am the employee named above and that I authorize release of records as specified.

Limitations, Revocation, and Retention

This authorization will remain in effect until the expiration date indicated above, or until revoked in writing by the Employee and delivered to the Human Resources department of the Employer. Revocation will not apply to disclosures already made in reliance upon this authorization prior to receipt of the revocation. The Employer may retain a copy of this authorization in the employee's personnel file.

Employment History

Employer 1

Employer 2

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: Nothing in this release alters any at-will employment relationship between the Employer and the Employee. Either the Employer or Employee may terminate employment at any time, with or without cause or prior notice, unless a separate written agreement provides otherwise.

Equal Employment Opportunity: The Employer is an equal opportunity employer. Release of records will be conducted in a manner consistent with applicable equal employment laws and Employer policies prohibiting discrimination and harassment.

Applicant Certification and Authorization to Contact

I certify that all information provided on this form is true and complete to the best of my knowledge. I authorize the Employer and any previous employers to release the requested information and to respond to inquiries from the designated recipient. I understand that knowingly providing false or misleading information may subject me to disciplinary action up to and including termination.

I further authorize the Employer to obtain background checks, reference checks, and other verifications as necessary to fulfill the request of the recipient, subject to any limits indicated on this form and applicable law.

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