Sample Employer Contact Log

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Sample   E mployer   C ontact   L og  
Date   o f   C ontact:       _ ______________________________  
Name   o f   C ontact:   _ ______________________________    
  h as   h iring   r esponsibility  
Purpose   o f   t he   C ontacts:  
  T o   s ecure   a n   a ppointment  
                                                                                           
    T o   l earn   a bout   t he   e mployer  
                                                                                         
  T alk   a bout   a   c andidate                                              
                                                                                       
    O ngoing   r elationship  
 
    O ther:   _ _______________________________________________  
Information   l earned   a bout   t he   e mployer’s   b usiness   a nd   h iring   p references   ( or   o ther   n otes):  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Next   s tep   ( include   d ate):      
 
 
 
 
  E mployment   s pecialist   s ignature:   _ _________________________________________________  
Dartmouth   P sychiatric   R esearch   C enter  
Revised   M arch   2 014  

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