Employee Privacy Release

EMPLOYEE PRIVACY RELEASE

Employer Name:    Location/Office:

Personal Information

Position Information

Reporting Manager:    Anticipated Start Date:

Employment History

Employer 1

Title/Position:    Start Date:    End Date:

Employer 2

Title/Position:    Start Date:    End Date:

Education

References

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: I understand and acknowledge that, unless otherwise expressly provided in a separate written agreement signed by an authorized representative of the employer, my employment is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or advance notice, subject only to applicable law.

Equal Employment Opportunity: The employer provides equal employment opportunity to all employees and applicants without regard to protected characteristics under applicable law. The employer makes employment decisions consistent with this policy and applicable legal requirements.

Authorization and Release

I hereby authorize the employer, its agents, contractors, and designated third-party service providers to collect, use, verify and disclose personal information about me for purposes of evaluating my employment and ongoing employment suitability. This includes, but is not limited to, verification of employment history, education, references, criminal history, credit reports where job-related and permitted by law, driving records, and other background screening as permitted by law.

I expressly authorize prior employers, educational institutions, licensing authorities, law enforcement agencies, courts, credit bureaus, and references to release information about me to the employer or its agents. I release such persons and entities from liability for furnishing such information in good faith and in response to inquiries from the employer.

  Employment and reference verification

  Education and credential verification

  Criminal history/background checks

  Credit report/financial background (job-related and where permitted by law)

  Drug or substance screening (if required)

  Fingerprint or biometric data collection (if required for position)

I understand that certain categories of personal information are sensitive and may require additional consent. I further understand that this authorization is voluntary, but refusal to consent may affect the employer's ability to consider me for certain positions or continued employment that requires such checks.

Revocation: I may revoke this authorization at any time by delivering a written revocation to the employer's human resources department. Revocation will not affect actions taken by the employer or third parties in reliance on this authorization prior to receipt of my written revocation.

Applicant Certification

I certify under penalty of perjury that the information I have provided in this Employee Privacy Release is true, correct, and complete to the best of my knowledge. I authorize the employer to rely on the representations made herein. I understand that any false statement or omission may constitute grounds for denial of employment or disciplinary action, up to and including termination.

By signing below, I acknowledge that I have read and understand this Employee Privacy Release, that I consent to the collection and use of my personal information as described above, and that I have received any required disclosures regarding consumer reports to be obtained in connection with this authorization where applicable.

Additional Notes (optional)

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