Dear
The person
identified below is being considered for
employment and
has signed a statement authorizing this
verification
and investigation. We shall appreciate a
statement of
your opinions and experiences as outlined
below. Your
reply will be considered confidential.
___________________________________
Name of
Applicant
___________________________________
Social
Security Number
___________________________________
Dates of
Claimed Employment
___________________________________
Position
Last Held
___________________________________
Final
Rate of Pay
Is the above
information correct? Yes______ No________
If not please
make corrections.
What is your
opinion as to this person's
Ability________________________Effort_________________________
Conduct________________________Attendance_____________________
Reason for
leaving your employ________________________________
______________________________________________________________
Eligible for
rehire? Yes_____No_____If not, why?_____________
______________________________________________________________
Your further
comments on any personal or professional strength
and weaknesses
will be appreciated.___________________________
______________________________________________________________
______________________________________________________________
Date__________Signed_____________________Title________________
