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Employment reference authorization form

>Employment reference authorization form
Employment reference authorization form 2023-08-25T07:55:40-07:00

Employment reference authorization form

 

Employment Reference Authorization Form

WASHINGTON POISON CENTER
APPLICANT INFORMATION
Address(Required)
AUTHORIZATION

I, the undersigned, authorize the Washington Poison Center to conduct a comprehensive employment background check and contact my past and present employers, references, and other sources for the purpose of verifying the information I have provided on my employment application and resume.

I understand that the information collected will be used solely for evaluating patient safety and my suitability for employment and will be handled with the utmost confidentiality in accordance with applicable laws and regulations.

REFERENCES
Please list at least three professional references below.
ACKNOWLEDGMENT AND SIGNATURE I certify that the information provided on this form is true and correct to the best of my knowledge. I understand that any false statements or omissions may result in disqualification from employment or termination if already employed.
Adding your name is considered a signature.
FOR OFFICE USE ONLY