REQUEST FOR AN EMPLOYMENT VERIFICATION LETTER

In accordance with the Freedom of Information and Protection of Privacy Act (FOIPP) the University of Alberta must have written consent from any employee, regardless of their current employment status, before any information on your employment or earnings may be released to a Third Party. In compliance with this legislation you must complete and sign a request form anytime you require the release of your information. Please be specific about the type of information concerning yourself that you are authorizing the University to release.

Employee Name (print clearly)
First, Middle Initial and Last Name
Former Name (if applicable)
Person ID / Date Required
(please allow 5 working days from date of request)
The University of Alberta Department you are currently employed at:
If not presently employed at the University, what were your dates of employment?
And your last Termination Date?

I am requesting an employment verification letter containing the following:

Position Title
Commencement Date / End Date
Full-Time Status / Part-Time Status
Current Salary (gross per month)
Other information to be released
Mail Verification Letter to: / (address must include postal code) Please Print Clearly
OR / Fax to () / OR / Phone () ()
Work Phone Home Phone
OR / Email me to pick up verification letter at

Request to release to third party: Please note that a separate request must be completed for each Third Party Request.

I hereby authorize the University of Alberta to prepare an Employment Verification Letter for me which will include the information I have indicted above.

Employee Signature / Date

The original request from the applicant and the department’s response must be retained for one year.