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Optional Reference Inquiry Form


Name of Pertinent Contact
Title
Company Name
Company Address
Company Address
RE:  (Name of Applicant)
Dear (Name of Pertinent Contact):
(Name of Applicant) has applied for the position of (specify) with our company and has  authorized us, in writing, to communicate with you for verification and reference information (copy of written authorization enclosed).  Kindly complete the enclosed information sheet and return it to us immediately.
Your assistance is greatly appreciated.
Very truly yours,
HR Professional
 

The Applicant provided the following data.  Kindly make changes or point out inconsistencies where applicable.
Applicant:   S.S. No.:
Address:   Phone No.:
Employed from to  
Reason for leaving:
Is the applicant eligible for rehire?       Yes       No
If not, please explain why.  Attach additional sheet(s) if necessary.

Using the rating scale given, please complete the chart below.

RATING SCALE:

A =       Exceeded job requirements
B =       Satisfied job requirements
C =       Did not satisfy job requirements



JOB FUNCTIONS AND NEEDSABC
1. OVERALL COMPETENCY
2. COMMUNICATION SKILLS
3. DISPOSITION & PERSONALITY
4. ABILITY TO FOLLOW INSTRUCTIONS
5. DESIRE TO SUCCEED
6. MOTIVATION
 
Date:
Name:
Title:

Copyright 1995 Steven M. Sack


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