Applicant Reference Release - Oregon
-236220-54864000APPLICANT REFERENCE RELEASE FORMName: (Please Print) Last First MII understand the Oregon Public Employees Retirement System (PERS) may be checking my references as part of the hiring process to learn about my work history. I give my permission for representatives of PERS to check references with any and all work-related contacts, such as those listed on my employment application, those provided specifically by me, and other contacts that may surface during the course of the hiring process. I understand that these references will be confidential and I will not have access to them. I also understand PERS will conduct reference checks in a professional manner. I release PERS and all providers of information from any liability as a result of furnishing and receiving this information.Applicant Signature: ____________________________________ Date: ____________Include professional contacts (e.g., supervisors, peers, and/or subordinates) that we may currently contact. Must include your current supervisor. Name, Title: Relationship: Company: Phone Number: Name, Title: Relationship: Company: Phone Number: Name, Title: Relationship: Company: Phone Number: Name, Title: Relationship: Company: Phone Number: ................
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