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-
- Dear
-
- The person identified below is being considered for
- employment and has signed a statement authorizing this
- verification and investigation. We shall appreciate a
- statement of your opinions and experiences as outlined
- below. Your reply will be considered confidential.
-
-
- ___________________________________
- Name of Applicant
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- ___________________________________
- Social Security Number
-
- ___________________________________
- Dates of Claimed Employment
-
- ___________________________________
- Position Last Held
-
- ___________________________________
- Final Rate of Pay
-
- Is the above information correct? Yes______ No________
- If not please make corrections.
-
- What is your opinion as to this person's
-
- Ability________________________Effort_________________________
-
- Conduct________________________Attendance_____________________
-
- Reason for leaving your employ________________________________
- ______________________________________________________________
-
- Eligible for rehire? Yes_____No_____If not, why?_____________
- ______________________________________________________________
-
- Your further comments on any personal or professional strength
- and weaknesses will be appreciated.___________________________
- ______________________________________________________________
- ______________________________________________________________
-
- Date__________Signed_____________________Title________________
-
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