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1. Employee Information: Details of the employee providing consent, including full name, current/former position, and dates of employment
2. Scope of Consent: Detailed specification of what information is authorized for disclosure, including employment dates, job titles, job responsibilities, performance evaluations, and salary information
3. Duration: Specification of the time period for which the consent remains valid, including start date and expiration date if applicable
4. Authorization Statement: Explicit consent statement acknowledging understanding and agreement, including signature block, date, and witness provisions
1. Revocation Rights: Section detailing the process and conditions under which consent can be withdrawn, including notification requirements
2. Third Party Recipients: Specific identification of parties authorized to receive information, including potential employers or verification services
3. Limitation of Liability: Provisions releasing the former employer from liability for providing authorized information in good faith
1. Schedule A - Authorized Information Checklist: Detailed checklist of specific information categories that may be shared, including performance ratings, attendance records, and reason for departure
2. Schedule B - Authorized Recipients List: Comprehensive list of specific companies, organizations, or individuals authorized to receive reference information
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