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CITY OF EUGENE <br /> RELEASE FROM LIABILITY <br /> Employee Name: <br /> Employee ID Number: <br /> RELEASE FROM LIABILITY: This release is completed and signed by the employee. <br /> If this release is not completed and signed, or, if the employee marks the NO box, <br /> reference information CANNOT be given to prospective employers unless an <br /> acceptable, subsequent release has been received by the City <br /> YES. I authorize the City of Eugene and its agents to furnish any prospective <br /> employer reference information concerning my employment record, work performance, <br /> work conduct and reasons for termination. Information of a confidential or privileged <br /> nature. may be included. I hereby release the City of Eugene and its agents from any <br /> liability or damage which may result from furnishing the information requested. <br /> NO. 1 have read the above statement and do not wish to authorize the release <br /> of such information. <br /> Employee Signature & Date Witness Signature & Date <br /> Supervi$or's Guide January, 1996 <br /> <br /> Employee-Relations Page 32 <br /> <br />