Pre-Employment Reference Request - Sunwest Employer Services printable pdf download

Pre-Employment Reference Request

Company ____________________

Reference:

______________________________

Title: ________________________________

______________________________

Relationship to Candidate ________________

______________________________

Candidate:

______________________________

Social Security #: _____________________

The above individual has applied for employment with our company and has listed your company as one of his/her past employers. The signed

release located at the bottom of this form authorizes your company to provide answers to the following questions while protecting you from legal

liability.

Dates of Employment: from ______________ to _______________

Is that correct? _____________

Eligible for Rehire: ______________________ Explanation? __________________________________

Position(s) Held: ______________________ Rate of Pay: __________ Is that correct? _____________

Nature of Work/Job Responsibilities: _____________________________________________________

____________________________________________________________________________________

What were his/her most outstanding attributes? ______________________________________________

____________________________________________________________________________________

What were his/her areas needing development? ______________________________________________

____________________________________________________________________________________

How would you rate his/her conduct in the workplace: (please ✔ frequency of behavior)

Always

Frequently

Occasionally

Never

Interacts professionally with management

_____

Works well w/ others to accomplish tasks

_____

Supports and defends company policies

_____

Produces work of expected quality

_____

Is flexible in work schedules

_____

Demonstrates good attendance

_____

Is prompt for shifts as scheduled

_____

Follows all security/safety procedures

_____

Does not possess nor use illegal drugs

_____

Is trustworthy with company property

_____

Please comment on those items marked “Occasionally” and “Never.” ________________________

________________________________________________________________________________

Would you recommend this candidate?__________ If No, Why not?_____________________________

____________________________________________________________________________________

Authorization to Release Information

I authorize each of my former employers to answer the above questions and to release all records of my employment, including performance

evaluations, as requested by the above listed company in connection with my application for employment with that company. I release my

former employers from any and all liability for providing this information.

Pre Employment Reference Request 3/25/02

Sunwest Employer Services Inc.

Pre-Employment Reference Request - Sunwest Employer Services

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