List below present and past employment, beginning with your most recent:
I desire that Valiant Living be fully advised of my record with former employers.
Therefore, I request and authorize the release of information from my records in response to any requests from
Valiant Living. I understand that the information I am authorizing to release includes factual employment information
and also can involve records or assessments of my abilities, performance, attendance, productivity, attitude, conduct
and other work-related characteristics or issues.
I hereby release from all liability of any type whatsoever arising out of or related to the reference process, and
agree not to file or pursue any complaints, claims, or legal actions of any kind against the past employer, employees,
representatives, or agents arising out of their activites or actions performed in connection with disclosure of
information for the employers indicated below: