Job Applicant Employment Verification Form

Dear
The person identified below is being considered for

employment and has signed a statement authorizing this

verification and investigation. We shall appreciate a

statement of your opinions and experiences as outlined

below. Your reply will be considered confidential.


___________________________________

Name of Applicant
___________________________________

Social Security Number
___________________________________

Dates of Claimed Employment
___________________________________

Position Last Held
___________________________________

Final Rate of Pay
Is the above information correct? Yes______ No________

If not please make corrections.
What is your opinion as to this person's
Ability________________________Effort_________________________
Conduct________________________Attendance_____________________
Reason for leaving your employ________________________________

______________________________________________________________
Eligible for rehire? Yes_____No_____If not, why?_____________

______________________________________________________________
Your further comments on any personal or professional strength

and weaknesses will be appreciated.___________________________

______________________________________________________________

______________________________________________________________
Date__________Signed_____________________Title________________