Employment And Education Reference Check Consent And Release Form
Download a blank fillable Employment And Education Reference Check Consent And Release Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Employment And Education Reference Check Consent And Release Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Applicant #
Office of Human Resources, 4301 West Markham #566, Little Rock, AR
_________
72205-7199
Office: 501-686-5650
Employment and Education Reference Check Consent and Release
I, __________________________, hereby give consent to any and all current or prior employers or schools, to provide the
information requested below with regard to my employment and education history to the following:
Department _______________________ Contact _______________________ Phone: ____________ Fax: _____________
This consent is valid for a period of six (6) months from the date indicated below.
Applicant Name:________________________________________________
Last Four of SSN:_______________________
Applicant signature: _______________________________________________________
Date:_______________________
Thank you for assisting us with our screening process. Employment references are essential to our making informed hiring decisions.
Please take a few minutes to complete the form below. We ask that you answer all of the questions as best as you can, even if you
do not have direct experience working with the candidate in a particular area.
Company Name: ______________________________________
Dates of employment: _____________________________
Current or last job title: ________________________________
Current or last rate of pay: __________________________
Eligible for rehire: _____________________________________
Reason for separation: _____________________________
Any documented concerns in the last 12 months regarding the following:
YES
NO
Attendance, Punctuality or Reliability other than for legitimate medical or family leave reasons?
Integrity or effectiveness in handling the organization’s resources for which they were responsible?
Integrity or effectiveness in the professional interactions for which they were responsible?
The ability to accept responsibility or maintain productivity on the assignments for which they were
responsible?
The ability to exhibit maturity, composure, or professional conduct under typical job stresses or challenges?
Please indicate your evaluation of the applicant with a check mark in the appropriate fields.
Superior
Excellent
Good
Average
Below
Average
Intellectual Ability
Written Communication Skills
Oral Communication Skills
Relationships with Colleagues
Relationships with internal/external Customers
Adaptability
Reaction to Constructive Criticism
Leadership
Conflict Resolution
EDUCATION VERIFICATION:
School Name: ________________________________________
Degree Earned: _____________________________________
Dates Attended: ______________________________________
GPA Achieved: ______________________________________
Printed name of Representative providing information: _____________________________________________________________
Signature of Representative providing information: ____________________________________________ Date: ______________
This form must be maintained with interview records for a minimum of three years.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business