REFERENCE CHECK

    REFERENCE CHECK

    APPLICANT’S INFORMATION

    APPLICANT’S NAME

    DATE OF APPLICATION

    PREVIOUS EMPLOYER

    ADDRESS OF FORMER EMPLOYER

    TELEPHONE OF FORMER EMPLOYER

    REASON I MAY RECEIVE BAD REFERENCE, IF ANY

    I GIVE CCF PERMISSION TO OBTAIN A WORK RELATED REFERENCE FROM
    THE ABOVE MENTIONED FORMER EMPLOYER.

    APPLICANT’S SIGNATURE

    OFFICE USE ONLY

    EMPLOYEE INFORMATION

    (APPLICANT DO NOT WRITE IN THESE SPACES)

    START DATE
    END DATE

    POSITION AND DUTIES

    REASON FOR LEAVING OR TERMINATION:

    WOULD YOU REHIRE? IF ANSWER IS NO. REASON WHY.

    QUALITY OF WORK:

    GOOD

    FAIR

    POOR

    WORKS WELL WITH OTHERS:

    GOOD

    FAIR

    POOR

    JOB KNOWLEDGE/SKILLS:

    GOOD

    FAIR

    POOR

    ATTENDANCE/DEPENDABILITY:

    GOOD

    FAIR

    POOR

    COMMENTS (any other information you would like to share with us regarding this applicant?)

    HOW VERIFIED:

    PHONE

    MAIL

    FAX

    INFORMATION PROVIDED BY:

    TITLE

    DATE

    NAME OF REP. COLLECTING INFORMATION:

    TITLE

    DATE

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