Fill and Sign the Employment Release Form

Post-Employment Information Release Agreement Agreement made on the _________________ (date) , by _______________________ (Name of Employee) of ________________________________________________________ _______________________________ (street address, city, state, zip code) , referred to herein as Employee , in favor of ____________________________ (Name of Employer) , a corporation organized and existing under the laws of the state of ________________, with its principal office located at ________________________________________________________ ___________________________________ (street address, city, state, zip code) , referred to herein as Company . For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Employee hereby authorizes Company to release information to prospective employers regarding his employment with the Company, including, but not limited to;  Dates of employment;  Salary history;  Employment history;  Disciplinary actions;  Attendance record;  Performance; and  Employment related documents. Employee hereby releases Company, its agents, officers, directors, and affiliates from any and all liability for damages of whatsoever kind which may at any time result to Employee or his family because of compliance with this authorization and request to release information or any attempt to comply with it. This release is executed with the full knowledge and understanding that the information to be provided is for the sole purpose of gaining employment and shall remain in effect until such time as the Employee withdraws said release in writing to __________________________ (Name of Company) . WITNESS our signatures as of the day and date first above stated. ________________________ (Name of Company) ________________________ By:_________________________ (P rinted Name of Employee) _________________________ ________________________ (P rinted name & Office in Corporation) (Signature of Employee) _________________________ (Signature of Officer)