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Declaration of consent to contact reference form

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Reference request template toolkit:

If you need to request a reference for a new employee, use this model form to gain declaration of their consent for you to contact their former employer.

You can then send this with each reference request.

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What is a Declaration of consent to contact reference form?

A Declaration of Consent to Reference form is used when an individual is applying for a job. The purpose of the form is to obtain the applicant's consent to allow the employer to contact and obtain information from individuals or organisations who can provide a reference for the applicant.

The form typically includes the applicant's name, contact information, and a statement indicating that the applicant consents to the release of information by their references. It may also include a space for the applicant to list the names and contact information of the individuals or organisations who will be contacted as references.

By signing the Declaration of Consent to Reference form, the applicant is acknowledging that they have read and understand the purpose of the form, and they are giving their permission for the employer to contact their references.

Issued by who, to whom
Who should issue this form, and to whom?
The Employee to the Employer (you)
Applicable legal jurisdictions
In which jurisdictions can this form be used?
Great Britain & NI (United Kingdom), Worldwide

What legislation and best practice guidelines have been taken into account in the development of this template?

United Kingdom

A UK employer should issue a Declaration of Consent to Reference form in order to comply with data protection regulations and to ensure that they are obtaining accurate and relevant information about job candidates.

Under the General Data Protection Regulation (GDPR) and the Data Protection Act 2018, employers must have a lawful basis for processing personal data, including information obtained from references. The Declaration of Consent to Reference form provides evidence that the job candidate has given their explicit consent for the employer to obtain information from their references.

Additionally, the form helps to ensure that the employer obtains accurate and relevant information about the candidate, as it allows the candidate to choose which references to provide and to indicate which information they are comfortable with being disclosed. This can help to prevent misunderstandings or misrepresentations about the candidate's skills or experience, and can ultimately help the employer to make a more informed hiring decision.

Other territories

Consult your jurisdiction's employment legislation or labor laws to ensure compliance with the template. Review the language for local precision.

Declaration of consent to contact reference

Please read the information on this form carefully and completely.

I have applied for employment with [company name] and have provided information about my previous employment. I authorise [company name] 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 demeanour, rehire potential, dates of employment, salary and employment history.

My signature below authorises my former or current employers and references to release information regarding my employment record with their organisations and to provide any additional information that may be necessary for my application for employment with [company name], whether the information is positive or negative. I knowingly and voluntarily release all former and current employers, references, and [company name] 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 [company name].


Full name:  

Version: [1.0]

Issue date: [date]

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Reference request template toolkit:

In which communication or process sequence does this template belong?

Previous step
Offer of employment letter template

After choosing the right person for the job, after making a verbal offer send them an offer letter for them to formally respond to.

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Declaration of consent to contact reference form template
Next step
Reference request letter template

If you are recruiting a new employee and wish to request a reference from a previous employer, send this this model letter template to request confirmation of their employment.

Declaration of consent to contact reference form
declaration of consent to contact reference form