Employment Reference Request Form (Mail)



[Name of Reference]

[Title of Reference]

[Reference Company Name]


Regarding: [Candidates Name]


We are contacting you to verify employment of the above individual with your organization. This individual has applied with our organization for the position of [Position Title]. Attached please find a copy of the applicants signed consent form releasing prior employers to provide our organization information on [his/her] employment history, salary and performance. We appreciate your time and attention to this matter. If you have any questions, please contact me directly at [phone number and email address].


[Name, Title]

[Company Name]


[Candidates Name]

Dates of employment (month/year): Start Date: _____________ End Date: _____________

Job title(s): ________________________________

Primary job duties: _______________________________________________________

Quality of work: __________________________________________________________

Was it a voluntary or involuntary separation of employment? ________________________

Reason for employment separation: ___________________________________________

Eligible for rehire? (circle one): Yes / No.   If No, why? _______________________________

Above information was completed by:

Company Name: ___________________________

Printed Name: _____________________ Title: _____________________________

Signature:  ________________________ Date: ____________________________


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