Warning:
These forms are provided AS IS.  They may not be any good.  Even if they are good in one state or 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.

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 state or 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.