Free Fillable Authorization To Obtain Employment Information

This is a great form. You can do a lot with it. But sometimes you want more, like instructions, examples, different formats, editable and of course attorney prepared. You can find one of those with this Authorization To Obtain Employment Information for just a few dollars.

Name of person
City of person
Name of Employer
Name of Law Firm
Date of Injury

We DO NOT collect or save the information you entered



I, _________________________________ of ___________________________________________ ______________________________________________________________ , the undersigned, hereby authorize _______________________________________________________ , and any other firm or person by whom I am or I have been employed (the “Employer”), to give to the law office of ____________________________________________________ (“Law Firm”) any and all information in their possession regarding my employment, job title, nature of work, hours and time lost from work before and after the accident or occurrence of ______________________________________.

I further authorize the Employer to release all information related to amounts paid or due under any sick leave plan, wage continuation plan or group hospital or accident benefit plan, including the financial benefits received by me.

I agree that this authorization shall remain valid for one year from the date signed.


Dated this ______ day of ______________________, 20___.







When you need to get your employment information from a current of past employer to give to your attorney who is handling a case for you, it is necessary to use an Authorization form. This Authorization to Obtain Employment Information instructs your Employer to release your employment records to the law firm handling your case.


Simply fill out the fields on this page with the required information. Press the "Create Form" button. If you want a blank form, leave the fields as they are and click on the 'Create Form' button. On the next page you will be able to download your completed form. The form can then be edited further or just printed. That's all there is too it. We do not collect or save any of the information you enter in these forms. The information is solely used to fill out the form you are preparing.

Disclaimer: This form was not drafted by an attorney and is provided "As-Is" and may need substantial modifications to be valid. It should not be used as a legal document. By using any form on this site you agree that you are using them at your own risk.