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Referral Check
REFERRAL CHECK
[Date]
[Mr/Mrs/Ms/Dr] [First Name of previous employer] [Last Name of previous employer]
[Title of previous employer]
[Company of previous employer]
[Address of previous employer]
[City of previous employer ], [State of previous employer] [Zip Code of previous employer]
Dear [Mr/Mrs/Ms/Dr] [Last Name of previous employer]:
We would appreciate your assistance in verifying the information listed below regarding an employment application. All information will remain confidential and will be treated as such in our company personnel files. Enclosed is an authorization form for release of information signed by the applicant.
1. Please make any appropriate corrections for the information listed below. If all information is correct, please check the box at the end.
[Name of Employee], [Job Title]; SS# [Social Number Number]
Final Salary $ [Final Salary] annually; Employed from [First date of employment] to [Last date of employment]
Reason for Termination: [Relocation, Job Performance, etc.]
All above information is correct.
2. Would you re-hire this applicant? Yes No If no, why not?:
3. Please rate the individual for the categories below from a 1 Unsatisfactory to a 5 Outstanding.
Attendance 1 2 3 4 5
Work quality 1 2 3 4 5
Work quantity 1 2 3 4 5
Cooperation 1 2 3 4 5
Responsibility 1 2 3 4 5
We appreciate your assistance in this matter. A self addressed envelope is included for our convenience. Thank you for your time and cooperation.
Sincerely,
[First Name of employer] [Last Name of employer]
[Title of employer ]