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