<p> H OME C ARE Management Corporation</p><p>Authorization for Release of Information</p><p>I hereby authorize all of my former employers to release to HOMECARE Management Corporation all information regarding my employment with them, including my position, responsibilities, and job performance. I understand that this information then may be released to agencies with which HOMECARE Management Corporation has contracts when requested in conjunction with my working with clients of that agency. </p><p>I release from all liability the company and persons releasing this information, and I release HOMECARE Management Corporation from all liability for any damages from the disclosure of this information.</p><p>A photocopy or facsimile of this release of information shall have the same force as an original.</p><p>Printed/Typed Name______</p><p>Signed ______Date ______</p>