REQUEST FOR REFERENCE
Date:
To:
Re: Request for Reference for ______________________________
Dear:
The above-named individual has applied for a position with our company and indicates previous employment with your firm. The information requested below will help us to evaluate the applicant. We will hold your comments in strict confidence. Thank you for your cooperation.
Sincerely,
Human Resources Department
Please Indicate:
Job Titles:____________________________________________________
Dates of Employment From _________________ To ____________________
mm/dd/yy mm/dd/yy
Ending Salary $_____________________
Please rate the applicant on the basis of his employment with you (good/fair/poor):
Ability__________________Conduct___________________Attitude_________________
Efficiency_______________Attendance________________Punctuality______________
How many days was the employee absent from work for any reason during the prior 12 month period? _______________________
What was the reason for termination? ________________________________________
____________________________________________________________________________
Would you re-hire? ___________________. If not, give reason: ________________
____________________________________________________________________________
____________________________________ _____________________
Signature and Title Date
Warning:
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.
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