Employee Consent to Provide Post-Employment Reference Form

When employees leave your company, have them sign a written consent form that authorizes you to disclose employment reference information and releases your company from liability related to the reference. Here’s a template consent form that you can adapt based on your own circumstances.

I, _______________________________ request that ABC Company write a letter of

[Name of employee]

reference or respond to a reference check on my behalf. I understand that ABC Company will have to disclose personal information regarding myself, including job performance and personal characteristics to write a letter of reference or respond to a reference check on my behalf. I agree to the disclosure of this and other personal information (check one of the following):

 Only to the following individuals or organizations:

_________________________________________________________________

Name of contact   Name of Company   Address

_________________________________________________________________

Name of contact   Name of Company   Address

_________________________________________________________________

Name of contact   Name of Company   Address

 To all requests for references.

I hereby release ABC Company from any and all liability associated with the release of information related to my employment.

Employee Signature:

Date: