RELEASE OF PAYROLL INFORMATION
I, ,
hereby request that the Payroll Department of Bryn Mawr College (“the College”)
provide the information listed below to the person/entity listed below, in the
manner specified:
Information
to be released by the College:
__ Duplicate W2 year ___________
__ Payroll History
__ Other, please describe
Person/Entity
to whom I request information be provided:
Contact
method for information to be released (please check one):
__
Contact information (address, fax number, e-mail address to which I
request the above-listed information be transmitted):
In consideration of the provision of information by the College’s
Payroll Department to the above-named person/entity at my request, I do release
from any liability and agree not to sue Bryn Mawr College, its governing board,
officers, agents, employees, and any students acting as employees (“Releasees”), for any harm and expenses of any nature which
I may have or which may hereafter accrue to me, arising out of or related to
any loss, or injury that may be sustained by me due to the College’s provision
of this information.
Signature Date
(Last
four digits of social security number)