[l-Date]
To:
[r-Name]
[r-Address]
From:
[s-Name]
[s-Company]
[s-Address]
[s-Phone]
RE: [s-Reference]
Dear [r-FName]:
The person identified below is
being considered for employment and has signed a statement authorizing this
verification and investigation. We would
appreciate a statement of your opinions and experiences pertaining to the
individual as outlined below. Your reply
will be kept confidential.
___________________________________ _________________________________
Name of Applicant Social Security
Number
___________________________________ _________________________________
Dates of Claimed Employment Position Las Held
___________________________________
Final Rate of Pay
Is the above information
correct? Yes______ No________ If not please make corrections.
What is your opinion of this
individual regarding his / her:
Ability:
[s-AbilDescribe]
Effort:
[s-EffDescribe]
Conduct:
[s-CondDescribe]
Attendance:
[s-AttenDescribe]
Reason for leaving your employ:
[s-ReasDescribe]
Additional comments on personal or
professional strengths and weaknesses are appreciated.
[s-AdditDescribe]
Thank you for your assistance in
this matter.
______________________________ ________________
Signature Date
______________________________
Title
