Employment Reference Check

[Your Business]
[Street Address]
[City, State and Zip Code]

[Date]

[Former Employer]
[Street Address]
[City, State and Zip Code]

Re: Reference for [Applicant Name]
[Social Security Number]
[Position Held at Former Employer]
[Dates of employment]
[Provide information supplied by applicant for identification purposes.]

Dear [Former Employer]:

The above named individual has applied for employment with [Your Business] and has named you as a former employer.  In order to make an informed hiring decision, we need to know the applicant's work history.  [Applicant] has signed a release permitting you to provide us with the requested information, and a copy is attached.  Any information that you give will be held in the strictest confidence.  

Please verify employment by answering the following questions:

How long was [Applicant] with your company?	_________________________

Please provide all dates of employment:		_________________________

What position(s) were held by [Applicant]?		_________________________

What was the [Applicant's] final rate of pay?		_________________________

Was [Applicant] reliable?	___________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Was [Applicant's] work satisfactory? (If no, explain)	_________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Why did [Applicant] leave your employ?	_______________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Would you rehire this person?	_____________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Any remarks?	_______________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Information furnished by:	___________________________________________

Thank you for your cooperation and prompt response.

Sincerely,

[Your Name]
[Your Title]
[Your Business]