Employment Verification

First Name
Last Name
Cell Phone
Email
Previous Employer -1
Position Held
Dates of Employment - 1
Reason for Leaving
Supervisor
Phone
I authorize my prior employers to release any and all information relating to my employment with them to Stone Bridge Personnel Services. I further release and hold harmless my previous employers and Stone Bridge Personnel Services from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employers will be held in strictest confidence, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have the right to see the information. 
Signature 1
Date