Employment Records Authorization

[Style of Case]

AUTHORIZATION FOR RELEASE OF EMPLOYMENT RECORDS

TO ALL CURRENT AND FORMER EMPLOYERS OF [NAME OF PERSON AUTHORIZING RELEASE]:

I, [name of person authorizing release], authorize [name of person/firm authorized to obtain records] or any of [his/her/its] representatives to obtain all information pertaining to my employment, including, but not limited to, applications for employment, resumes, performance reviews, job descriptions, salary history, applications for insurance benefits, W-2s, W-4s, disciplinary and/or recognition records, workers’ compensation records, personnel records, employee benefits records, medical information, including physicals, work releases, etc., attendance records, e-mail records, separation agreements, releases, and any other records evidencing my employment with your company. I request that you deliver such records at their request and at their expense, upon presentation of this authorization or a photocopy thereof.

This authorization is to be used in connection with the above-captioned lawsuit filed by me. This authorization is valid until...