TELEPHONE REFERENCE CHECK

Date:______________Company name:__________________________________________________

Company representative:______________________________________________________________________

Applicant's name:__________________________________Social Security #:__________________________

Position applied for:__________________________________________________________________________

For Office Use Only:

Quality of work:______________________________________________________         Good     Fair    Poor

Quantity of work:_____________________________________________________         Good     Fair    Poor

Reliability:__________________________________________________________         Good     Fair    Poor

Dates of employment:                  From:__________________      To:__________________

Is the applicant eligible for rehire?      Yes__________     No_____________ If no, why not?

___________________________________________________________________________________________

_________________________________________________________Completed by:_______________

Date:______________Company name:__________________________________________________

Company representative:______________________________________________________________________

Applicant's name:__________________________________Social Security #:__________________________

Position applied for:__________________________________________________________________________

For Office Use Only:

Quality of work:______________________________________________________         Good     Fair    Poor

Quantity of work:_____________________________________________________         Good     Fair    Poor

Reliability:__________________________________________________________         Good     Fair    Poor

Dates of employment:                  From:__________________      To:__________________

Is the applicant eligible for rehire?      Yes__________     No_____________ If no, why not?

___________________________________________________________________________________________

_________________________________________________________Completed by:_______________