Applicant's Name:

PREVIOUS EMPLOYER

Employer's Name:

Interviewee Name:

Interviewee Title:

Phone No.:

QUESTIONS FOR PREVIOUS EMPLOYER

What was Applicant's Job Title?

What were the duties, functions and responsibilities of that job?

What were the Applicant's dates of employment?

What was the Applicant's last rate of pay?

Using the school grading system of "A" through "F", please rate the applicant's performance on the following:

JOB FUNCTIONS AND NEEDS

REMARKS

What was the Applicant's reason for leaving?

Would you re-hire the Applicant?

Are there any other pertinent facts you would like to add regarding the Applicant?

Interviewer's Comments: