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Human Resources

Reference Release
I hereby authorize that any of my previous employers may give and release to the Salt Lake County
Human Resources Division or to any other division of Salt Lake County, any and all information of
whatever kind in either written or verbal form which relates to my ability to perform the duties of the
position for which I am applying. Any or all of my previous employers may be contacted. I hereby
release Salt Lake County and any and all of my previous employers from any legal claim or liability,
including claims for defamation or invasion of privacy, for the use of this information in considering and
reviewing my application for the available position.

________________________________________ _______________________________

Signature Date

In addition to authorizing the contact of previous employers, I also authorize Salt Lake County to contact
my current employer under the same terms and conditions set out above.

________________________________________ _______________________________

Signature Date

Name:__________________________________
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1 Salt Lake County Human Resources Version Date: 12/10/2014