Request for reference
Request for reference form
REQUEST FOR REFERENCE
Date:____________________________
To:______________________________
Re:______________________________
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,
Personnel Department
Please Indicate:
Position With Your Firm:____________________________________________________
Employed From_______________________________Through_________________________
Final Salary $_____________________Social Security Number___________________
Please rate the applicant on the basis of his employment with you (good/fair/poor):
Ability__________________Conduct___________________Attitude_________________
Efficiency_______________Attendance________________Punctuality______________
What was the reason for termination?________________________________________
____________________________________________________________________________
Would you re-hire?___________________. If not, give reason:________________
____________________________________________________________________________
____________________________________
Signature and Title
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Request for reference
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