I am applying for a job at PMH Medical Center which provides health care to the public. I understand that in order for the hospital to make a knowledgeable hiring decision, they must check with prior employers.
I consent to and authorize PMH Medical Center to contact the above named former employer(s), and its agents and employees, to furnish any reference information concerning me, including achievement, wage history, performance, attendance, personal history, disciplinary information and reason for separation of employment, relating to my employment with the former employer. It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment.
I therefore release all parties or persons connected with any request for information from claims, liability and damages for whatever reasons arising out
of furnishing this information.
This release shall remain in effect for the length of my employment and pertain to future release of the above information for employment-related