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CONSENT TO RELEASE CONFIDENTIAL INFORMATION

Date:

To:[employee]

A request for release of confidential information has been received from [name of requesting person, agency, or company].

Please initial each of the items below for which you consent to the release of information regarding those data:

Salary:

Dates of employment;

Whether you worked under any other names:

Reasons for separation:

Position and duties:

Part-time or full-time employment:

Name of your supervisor:

Other information:

Please return to the human resources department.

Date:

________________________ Employee

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For Up-To-Date Forms Covering Just About Every State & Situation plus Summaries of
Relevant Laws We STRONGLY SUGGEST Checking Out
'LLL's 25,000+ Premium Forms - Every Subject, Every State
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