Reference Check Release Form

  • Release Statement

    I, (applicant named above), do hereby grant my complete permission to (employer[s] named above), with whom I am currently or was previously employed, to verify and release to LifeCare Alliance or its representatives information regarding my employment history, job performance, salary history, and work record while employed with the company. I further give permission to the company to answer all legal inquiries regarding my record while employed with the company.

    My electronic signature below confirms my agreement with (employer[s] named above) to release the above information regarding my employment experience with said company. I agree to release the company and its representatives from all liability for providing legal, relevant, and accurate information in good faith regarding my employment as a result of inquiries. I further agree not to take legal action against LifeCare Alliance or its representatives for release of requested information.

    This agreement will terminate one year from the date the applicant's electronic signature is applied to the agreement, unless the applicant specifically requests and signs a request for extension.