Legal Forms
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Authorization To Release Information
AUTHORIZATION TO RELEASE INFORMATION
Date: [Date of Notice]
[First Name of Recipient] [Last Name of Recipient]
[Company Name of Recipient]
[Street Address of Recipient]
[City of Recipient], [State of Recipient]
[Zip Code of Recipient]
[Country of Recipient]
Dear [Mr./Mrs.] [Last Name of Recipient]:
I have applied for a position with the following Company: [Name of Company].
As part of my application, I have been requested to provide information concerning my background and qualifications. Therefore, I authorize the investigation of my past and present work, character, education, military experience, and employment qualifications by the above Company.
The release in any manner of any and all information by you to the Company indicated above is authorized whether such information is of record or not. I do hereby release all persons, agencies, firms, companies, etc., from any responsibility for damages resulting from their provision of such information.
This authorization is valid for 90 days from the date of my signature below. Please keep this copy of my release for your files. Thank you for your cooperation.
Signature Date
Witness Date
Medical information is often protected by state laws and civil codes.
Consult your attorney if you wish to seek this information.