#8404
@001 Enter the name of the applicant:
@840 Enter the social security number of applicant:
@841 Enter the date of the application:
@842 Enter the position applied for:
@002 Enter the name of prospective employer:
@843 Enter name of person to reply to at employer:
@844 Enter the street address of the prospective employer:
@845 Enter the city, state of the prospective employer:
@846 Enter the telephone number of prospective employer:
#end control section
#8404
/* Para. 8404: Applicant's release of information */


               AUTHORIZATION FOR RELEASE OF INFORMATION


Name of applicant: @001

Social security number: @840

Date of application: @841

Position applied for: @842



TO: Former Employers, References


You are authorized to release information concerning my
employment with you, or if you are a personal/academic reference,
release information concerning my employment/education,
including subject evaluations to @002.


You are further released from liability in connection with your
response to this inquiry.


A photocopy of this authorization will be as effective as an
original.




___________________________________________

@001



@002

Attention: @843

@844

@845

Telephone: @846