Get documents about "Application Reference Check Form
Document Sample
Reference Name
Applicant: in this space provided
Street of P.O. Box at the left, please enter the name,
address and phone number of
reference you are submitting
City, State, Zip Code
Phone Number
I have applied for employment at The Center for Life Enrichment. I have read the material and questions below. I authorize you to
render the opinions and form the judgments to provide them with the information requested. I hereby release you and/or your
company from all liability whatsoever as a result of the completion of this reference.
Social Security Number Signature of Applicant Date
(APPLICANT: PLEASE DO NOT ENTER INFORMATION BELOW THIS LINE)
*************************************************************************************************
has listed you as a PERSONAL / BUSINESS reference. Please complete the
appropriate section. Information regarding the applicant will be treated as confidential.
WORK REFERENCE
Dates Employed: From To Position held
Eligible for rehire? Yes No Why?
Above Average Average Below Average Unsatisfactory
Attendance
Cooperation
Initiative
Job Knowledge
Quality of Work
PERSONAL REFERENCE
Length of time you have known applicant? In what capacity?
Would you recommend applicant for a position with The Center for Life Enrichment, Inc.? Explain why?
Date .
Signature and title
25089 Three Notch Road, P.O. Box 610, Hollywood, MD 20636
301-373-8100, ext. 813, Fax 301-373-3019
A United Way Agency
Reference Name:
Applicant: in this space provided
Street of P.O. Box at the left, please enter the name,
address and phone number of
reference you are submitting
City, State, Zip Code
Phone Number
I have applied for employment at The Center for Life Enrichment. I have read the material and questions below. I authorize you to
render the opinions and form the judgments to provide them with the information requested. I hereby release you and/or your
company from all liability whatsoever as a result of the completion of this reference.
Social Security Number Signature of Applicant Date
(APPLICANT: PLEASE DO NOT ENTER INFORMATION BELOW THIS LINE)
*************************************************************************************************
has listed you as a PERSONAL/BUSINESS reference. Please complete the
appropriate section. Information regarding the applicant will be treated as confidential.
WORK REFERENCE
Dates Employed: From To Position held
Eligible for rehire? Yes No Why?
Above Average Average Below Average Unsatisfactory
Attendance
Cooperation
Initiative
Job Knowledge
Quality of Work
PERSONAL REFERENCE
Length of time you have known applicant? In what capacity?
Would you recommend applicant for a position with The Center for Life Enrichment, Inc.? Explain why?
Date .
Signature and title
25089 Three Notch Road, P.O. Box 610, Hollywood, MD 20636
301-373-8100, ext. 813, Fax 301-373-3019
A United Way Agency
