Employee History/ Character reference Authorized release of information I, __________________________ currently employed with The Education Team authorize _________________________to release the information requested below. Previous employer/ reference ______________________________________________________ _____________________ Authorized by signature of employer Date Please assist us by answering the following questions. You may use the spaces provided or the back of the paper for your reply. 1. In what capacity have you known the applicant? employer co-worker friend other ___________________________________________________________________________ ___________________________________________________ How long have you known the applicant? _______________ months/ years For previous employers, is this applicant eligible for rehire? Dates of employment: yes no
2. 3. 4. 5.
From ________month/ year to ________month/year
Would you entrust children to the applicant’s care? yes no If no, please explain ________________________________________________________ _______________________________________________________________
6.
To the best of your knowledge, is the applicant of good moral character? If not, please explain. _______________________________________________ _______________________________________________________________
7.
Additional comments _____________________________________________ _______________________________________________________________
__________________________________________ Signature of person completing this form
___________________ Date _____________ Phone number
____________________________________________________________________ Address Thank you, please mail the completed form to: The Education Team 8950 Dr. Martin Luther King Jr. St. N. Suite 208 St. Petersburg, Fl. 33702 727-578-0999 phone / 727-578-0995 fax