Release of information consent 				Form 12

I understand that there are likely to be inquiries from future prospective employers regarding my performance during the time I worked here.

Please tick:

	I hereby consent to the release of information regarding my performance while I was employed by

	

 	I do not consent to the release of information regarding my performance while I was employed by

	

Comments:

	

Signed:		
Full name:		
Date:		

Instructions:
•	Ensure consent is signed by exiting employee
•	Keep copy in Human Resource File