Post-Employment Release Of Employment Information

I, , hereby authorize to release information to prospective employers regarding my employment with this company, including but not limited to, dates of employment, salary history, employment history, disciplinary actions, attendance record, performance, and employment related documents.

I hereby release my former and prospective employers, their employees, agents, officers, directors and affiliates from any and all liability for damages of whatever kind, which may at any time result to me, my family or associates, because of compliance with this authorization and request to release information or any attempt to comply with it.

This release is executed with 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 I withdraw said release in writing to the company named above.

Signature Date

I, , on behalf of hereby agree to hold harmless and indemnify for any claims arising from any information provided hereunder.

Signature Date

©1998 Phin Enterprises. Donald A. Phin, Esq., CPCM. No portion of these materials may be reproduced by any means without the express written permission of the author.