Application

Reference Checking Consent and Authorization Form

Please read the information on this form carefully and completely.

I have applied for employment with Lanracorp Inc. and have provided information about my previous employment. I authorize Lanracorp Inc. to conduct a reference check with my present and/or previous employer(s). I understand that reference information may include, but not be limited to, verbal and written inquiries or information about my employment performance, professional demeanor, rehire potential, dates of employment, salary and employment history.

My digital signature below authorizes my former or current employers and references to release information regarding my employment record with their organizations and to provide any additional information that may be necessary for my application for employment to Lanracorp Inc., whether the information is positive or negative. I knowingly and voluntarily release all former and current employers, references, and Lanracorp Inc. from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with Lanracorp Inc..

I further authorize Lanracorp Inc. to obtain feedback and references from my supervisors over the course of my employment with Lanracorp Inc. I understand that subsequent and continued employment with Lanracorp Inc. may be subject to this feedback.

This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a release or consent as the original which I sign.