Employee Image Release Consent Form
Please complete this form to provide your consent for the use of your image in corporate materials.
Employee Full Name
*
First Name
Last Name
Employee ID Number
*
Department
*
Please Select
Human Resources
Finance
Marketing
Sales
IT
Operations
Other
Position/Job Title
*
Work Email Address
*
example@example.com
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor/Manager Name
Type(s) of Image Use (Select all that apply)
*
Company Website
Social Media
Printed Materials (Brochures, Flyers, etc.)
Internal Communications
Press Releases
Other
Purpose of Image Use (Briefly describe how your image may be used)
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Signature (Please sign below to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: