• EMPLOYMENT VERIFICATION AUTHORIZATION AND RELEASE FORM

    Section I – To be completed by applicant - Please print clearly or type all information
  • I consent to and authorize the above-named former employer, and its agents and employees, to furnish any and all reference
    information concerning me to Cedas Home Care Services, LLC within one year of the date of this application, including
    achievement, wage history, performance, attendance, personal history, disciplinary information and reason for separation of
    employment, relating to my employment with the former employer. I also hereby release the above-named former employer, and its agents and employees, from all liability for damages or claims including, but not limited to defamation, interference with contract, or prospective economic advantage and negligence, I have or may have which arise or result from any reference information provided pursuant to this authorization. I acknowledge that a facsimile or copy of this release shall be as valid as the original.

  • Section II – To be completed by applicant’s previous employer
  • The above applicant is seeking employment with the above company and has listed your organization as a former place of
    employment. In accordance with the Release signed by the applicant, please provide the information requested below. We appreciate your cooperation in providing the information and answering the following questions. Your response will be held in the strictest confidence and will not be shared with the applicant. Thank you in advance.

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