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CITY AND COUNTY OF BROOMFIELD AUTHORIZATION TO RELEASE EMPLOYMENT INFORMATION I, do hereby Name of Employee authorize the Human Resources Department to release copies of information in my personnel file, including but not limited to any employment records, reports, applications and/or documents of any kind whatsoever. Such information also includes salary, position held, length of employment, and level of fringe benefits relating to my employment at any time whatsoever. Name of Person/Organization Requesting Information is authorized to receive copies of the above information concerning my employment with the City and County of Broomfield. In executing this authorization, I expressly waive any privileged or confidential communication between me and the City and County of Broomfield. Such waiver is solely and only for the purpose of authorizing the above person/organization to obtain this information. No other person or organization is authorized to receive this information by this release and waiver. Employee’s Signature Date Important Note** Employee may withdraw this authorization by written request at any time. For convenience, you may use the form provided below. If this authorization is not withdrawn, it will automatically expire two months after the date indicated above. I hereby withdraw the above authorization. Employee’s Signature Date