CITY OF OAKLAND
Planning & Building Department
Revised 08/12/16
REFERENCE CHECK AUTHORIZATION
I, __________________________________, give the Planning & Building Department
permission to check the references that I am providing below, in order to obtain any
information needed to assess my qualifications and suitability for employment. I hereby
release the Planning & Building Department from any liability or damage that may result from
obtaining information. I specifically authorize each of the references that I have listed to
provide all requested information to the Planning & Building Department, and I release any
and all such references from liability for providing information requested by the Planning &
Building Department.
Signature: ________________________________ Date: ____________________
Important Note: Your professional references should include your 2 most recent
managers/supervisors, unless you check the box below indicating that you do not wish for us
to contact your present manager/supervisor.
May we contact your present manager/supervisor? Yes No
Professional References:
Manager’s/Supervisor’s Name
Company/Organization
Telephone Number
AND/OR
Please contact the references I provided on my application Yes No
****Please have this form completed and ready to submit at your scheduled interview*****
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