Employee Reference Check Form

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Employee Reference Check
Print Employee Name: _________________________________________________
Employee Signature: ____________________________________________________
Company to contact: ______________________________________
Name to contact: ______________________________________
Phone#_______________________________________
Fax# If known_________________________________________
_________________________________________________________________________________________________
OFFICE USE ONLY
________________________________________________________ Is Seeking Employment with our company. It is our
policy to ask for references prior to employment. Please complete this form for our records & Sign
below. We would Greatly Appreciate your assistance
PLEASE VERIFY EMPLYMENT DATES:
From: _______________________________________
to: ______________________________________________
Eligible for rehire?
YES
NO
Comments:
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Information was received by
Phone
E-mail
Fax
Name of Representative & Title
Aseel Slewa (HR Department)
Date:_____________________________

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