Employment Reference Letter Release Form

Employment Reference Letter Release Form

Recitals

WHEREAS, Employee Name: seeks to obtain an employment reference or letter of recommendation from Employer Name: for purposes of prospective employment or professional opportunities; and

WHEREAS, the Employee authorizes the Employer and its authorized representatives to provide factual and evaluative information about the Employee's employment history as described below to Prospective Recipient: .

WHEREAS, the parties wish to document the scope of that authorization and Employee's release of liability to the extent permitted by law.

Authorization and Scope of Information

I authorize the Employer and its authorized agents to prepare, provide, and disclose an employment reference letter and to respond to inquiries from the prospective recipient(s) named below. This authorization includes disclosure of the specific categories of information permitted below and any factual employment verification the Employer customarily provides.

Employment dates (start and end)

Job title(s) and department

Summary of primary job duties

Performance evaluations or qualitative assessment

Eligibility for rehire

Reason for separation/termination

Compensation or salary information (check to permit disclosure)

Permitted Recipients and Contact Authorization

The Employee authorizes disclosure to the following recipient(s). If left blank, authorization extends to any prospective employer who requests an employment reference in connection with a specific opportunity identified by the Employee.

Contact methods authorized:

Telephone inquiry Email inquiry Written reference letter

Release and Waiver

In consideration for the Employer's provision of information at my request, I hereby release and forever discharge the Employer, its officers, directors, employees, agents, and representatives from any and all claims, demands, liabilities, and causes of action arising out of or resulting from the release of information authorized by this form, including but not limited to claims for defamation, invasion of privacy, negligent or intentional misrepresentation, or any other claim related to the disclosure of employment-related information to the authorized recipient(s), to the fullest extent permitted by applicable law.

I acknowledge that this release does not obligate the Employer to provide a reference or to disclose any information that is protected by law, contract, or the Employer's policies. The Employer retains the right to decline to comment on certain topics.

Confidentiality and Use

The recipient shall use any information provided under this authorization solely for the purpose of evaluating the Employee's suitability for employment or related professional purposes. Recipients are requested to maintain the confidentiality of the information to the extent required by applicable law.

Revocation; Duration

This authorization shall remain effective from the Effective Date provided below until revoked in writing by the Employee. A written revocation will not affect disclosures already made in reliance on this authorization prior to receipt of the revocation by the Employer.

Additional Instructions / Scope

Governing Law; Miscellaneous

This Release shall be governed by and construed in accordance with the laws of the state specified below without regard to conflict of law principles. If any provision of this Release is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

This Release constitutes the entire agreement between the parties regarding the subject matter herein and supersedes all prior or contemporaneous oral or written agreements related to the authorization and release of employment information.

Certification

I certify that I am the individual named above or have lawful authority to act on behalf of the named individual. I have read this Release, understand its terms, and sign it voluntarily. I understand that I may request a copy of this signed Release from the Employer.

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