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WordStar Document  |  1993-08-01  |  1KB  |  35 lines
  1.  
  2.  
  3. AUTHORIZATION FOR RELEASE OF INFORMATION
  4.  
  5. Name of applicant: _________________
  6. Social security number: ____________
  7. Date of application: _______________
  8. Position applied for: ______________
  9.  
  10.  
  11. TO: Former Employers, References
  12.  
  13. You are authorized to release information concerning my employment 
  14. with you, or if you are a personal/academic reference, release 
  15. information concerning my employment/education, including subject 
  16. evaluations to ______________________.
  17.  
  18. You are further released from liability in connection with your 
  19. response to this inquiry.
  20.  
  21. A photocopy of this authorization will be as effective as an 
  22. original.
  23.  
  24.  
  25. ___________________________________________
  26.  
  27.  
  28.  
  29. ____________________________
  30. Attention: _________________
  31. ____________________________
  32. ____________________________
  33. Telephone: _________________
  34.                            
  35.