This Separation and Release Agreement ("Agreement") is made and effective this [Date],
BETWEEN:[Employee NAME] (the "Employee"), an individual with his main address at:
AND:[YOUR COMPANY NAME] (the "Company"), a corporation organized and existing under the laws of the [State/Province] of [STATE/PROVINCE], with its head office located at:
[YOUR COMPLETE ADDRESS]
NOW, THEREFORE, in consideration of the mutual covenants set forth herein and intending to be legally bound, the parties hereto agree as follows:
The Employee hereby authorizes Company to release information to prospective employers regarding his employment with this company, including but not limited to, dates of employment, salary history, employment history, disciplinary actions, attendance record, performance, and employment related documents.
The Employee hereby releases his former and prospective employers, their employees, agents, officers, directors and affiliates from any and all liability for damages of whatever kind, which may at any time result to Employee, his family or associates, because of compliance with this authorization and request to release information or any attempt to comply with it.
This release is executed with full knowledge and understanding that the information to be provided is for the sole purpose of gaining employment, and shall remain in effect until such time as the Employee withdraws said release in writing to the [YOUR COMPANY NAME] above.