CONSENT TO PROVIDE EMPLOYMENT HISTORY TO PROSPECTIVE EMPLOYERS
I, ____________________________ (applicant), hereby give consent to Banner County Public School to provide information with regard to my employment with Banner County Public School to ___________________________________ (prospective employer(s)).
I consent to Banner County Public School giving the following information about me to the afore-named prospective employer(s):
1. Date and duration of employment;
2. Pay rate and wage history on the date of receipt of this consent;
3. Job description and duties;
4. The most recent written performance evaluation prepared prior to the date of the request for information and provided to me during the course of my employment;
5. Attendance information;
6. Results of drug or alcohol tests administered within one year prior to the request for information;
7. Threats of violence, harassing acts, or threatening behavior related to the workplace or directed at another employee;
8. Whether I was voluntarily or involuntarily separated from employment and the reasons for the separation; and
9. Whether I am eligible for rehire.
The consent is valid for six months from the date of my signature below.
Name:_______________Date________________
