Consent To Contact References
I , __________________________ hereby authorize the Corporation of the City of Mississauga (the“City”) to contact the person(s) and/or
organization(s) listed below for the purposes of obtaining employment reference information including information contained in my
personnel file and hereby authorize those persons and/or organizations to disclose such information.
In addition, I hereby authorize the City to contact any employers listed on my resume and/or any other employer of which the City
becomes aware of during the course of the candidate selection process or reference check for the purposes of obtaining employment
reference information including information contained in my personnel file and hereby authorize those persons and/or organizations to
disclose such information.
The following work related references are authorized to disclose such information:
Current/Most Recent Supervisor/Mgr. Name:
Company:
Working Relationship to Candidate:
Telephone Number:
Email Address:
Contact Name & Position:
Company:
Working Relationship to Candidate:
Telephone Number:
Email Address:
Contact Name & Position:
Company:
Working Relationship to Candidate:
Telephone Number:
Email Address
Comments:
NOTE: The City reserves the right to verify any educational/certification documentation as required for the position applied for.
This personal information is collected under the authority of the Municipal Act, 2001, S.O. 2001 c. 25, as amended. The information will
be used for employment purposes only. Questions about the collection of this information may be directed to:
The Office of the City Clerk
300 City Centre Drive
Mississauga, ON L5B 3C1
905-896-5000
__________________________ _______________________
Candidate’s Signature Date
Date Created: June 23, 2014
Date Revised:
