Employee Reference Release Agreement

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Date

{{date}}

To Whom It May Concern,

I, {{employee_full_name}}, hereby authorize {{company_name}} (the "Company") to release information regarding my previous employment with the Company to the following individual/organization (the "Requesting Party"):

Requesting Party Details

Name of Individual/Organization: {{requesting_party_name}}

Address: {{requesting_party_address}}

Contact Person: {{requesting_party_contact_person}}

Contact Number: {{requesting_party_phone}}

Email Address: {{requesting_party_email}}

Information to be Released

I authorize the Company to release the following information about my employment:

1. Dates of Employment: {{start_date}} to {{end_date}}

2. Job Title(s): {{job_title_list}}

3. Key Responsibilities and Duties: {{key_responsibilities}}

4. Reason for Leaving: {{reason_for_leaving}}

5. General Performance Rating: {{performance_rating}}

6. Eligibility for Rehire: {{rehire_eligibility}}

7. Any other specific information requested by the Requesting Party and deemed appropriate for release by the Company.

Waiver and Release of Liability

I understand and agree that any information provided by the Company in response to this request will be done so in good faith. I hereby release, discharge, and agree to hold harmless {{company_name}}, its officers, directors, employees, and agents from any and all liability, claims, demands, damages, or causes of action whatsoever, which may arise from or relate to the disclosure of such information.

I further waive any right to review the information provided by the Company to the Requesting Party.

Duration of Authorization

This authorization shall remain in effect for a period of {{duration_in_months}} months from the date of my signature below, or until I provide written revocation of this authorization to the Company, whichever occurs first.

Employee Declaration

I confirm that I have read and understood the terms of this Employee Reference Release Agreement and voluntarily grant this authorization.

Employee Name: {{employee_full_name}}

Employee ID: {{employee_id}}

Signature

_________________________________________

Employee Signature

Date: {{signature_date}}

Company Representative (Optional)

_________________________________________

Name and Title (Company Representative)

Date: {{company_signature_date}}