Applicant Work Verification Form printable pdf download

Applicant Work Verification Form

APPLICANT WORK VERIFICATION FORM

SECTION 1

(To be completed by applicant)

APPLICANTS NAME: ______________________________________________________________

(Please Print)

DATE:_________________

POSITION APPLIED FOR:

_______________________________________

I, ______________________________authorize the release of information concerning my qualifications

(Applicant’s Signature)

for employment with Beechwood Homes.

The individual listed above has applied for a position with Beechwood. Please take a few moments to

complete the form below to help us evaluate the applicant for employment with Beechwood.

SECTION 2

(To be completed by the individual providing the reference)

PLEASE PRINT

Name of Person Completing the form: ___________________________________________________

How do you know the applicant? Please check ( ):

________ School ________Volunteer Organization

_______Professional Affiliation

________ Previous/Current Employment

Position Held: _______________________________________________________________________

Dates employed: From ___________ To ___________ Eligible for Rehire: ____Yes ____ No

How long have you known the applicant?: _____________________________________

Do you feel that the applicant has the qualities required to work with the elderly? ___Yes ___No

Name of Company/Facility: ____________________________________________________________

Phone #: _____________________________ Best Time To Contact: __________________________

_________________________________

___________________________

____________

Signature of Person Completing Form

Title

Date

Please mail to: Attn: H.R. Dept., 2235 Millersport Hwy., Getzville, NY 14068

Or fax to: (716) 810-7278 or (716) 810-7279 or (716) 810-7291

Rev. 02/15

Applicant Work Verification Form