REFERENCE CHECK RELEASE & CONSENT FORM

Candidate information

• **Full name:** [CANDIDATE NAME]
• **Phone:** [PHONE]
• **Email:** [EMAIL]
• **Position applied for:** [JOB TITLE]

Authorization

I, [CANDIDATE NAME], authorize [COMPANY NAME] ("Company") and its agents to contact the references I have provided, as well as former employers, educational institutions, and other sources, to verify information related to my application for employment, including job performance, attendance, responsibilities, and eligibility for rehire.

I release the Company, its employees and agents, and all persons and organizations providing information in good faith from any liability arising from this reference-check process, to the fullest extent permitted by law.

Background screening disclosure (if applicable)

[IF THE COMPANY RUNS CONSUMER-REPORT BACKGROUND CHECKS: The Company may obtain a consumer report and/or investigative consumer report for employment purposes, in compliance with the Fair Credit Reporting Act (FCRA) and applicable state law. A standalone FCRA disclosure and authorization will be provided separately. DELETE THIS SECTION IF NOT APPLICABLE.]

References provided

1. Name: ______________________ Relationship: ______________________ Phone/Email: ______________________
2. Name: ______________________ Relationship: ______________________ Phone/Email: ______________________
3. Name: ______________________ Relationship: ______________________ Phone/Email: ______________________

I certify that the information I have provided is true and complete. I understand that false statements may disqualify me from employment or result in termination if discovered later.

Candidate signature: ___________________________  Date: ______________

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For HR use only — Received by: ______________ Date: ______________ References checked: [ ] 1 [ ] 2 [ ] 3

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General template only — not legal advice. Have employment counsel review before use, especially for state-specific requirements. Downloaded from AskHrAI (https://askhrai.com/forms/reference-check-consent).