© Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by International treaties. IT IS
ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER
PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

July 11, 2024

[FORMER EMPLOYER NAME]

Address
Address2
City, State/Province
Zip/Postal Code

OBJECT: REFERENCE CHECK FOR [APPLICANT NAME] – [SOCIAL SECURITY NUMBER]

Dear [FORMER EMPLOYER NAME],

A former employee of your company, [APPLICANT NAME], has applied for a position with our company.

As part of interview process, we are hereby requesting background information from you on this

employee. [HE/SHE] has given us permission to request such information from you and a copy of such

request is attached hereto.

Please provide us the following information concerning this former employee:

Dates of employment: Positions held:

Responsibilities:

Last total salary and bonus while employed:

Reason given for terminated/leaving:

How would you rate his/her overall competence? (Check one.)

Outstanding Good Average Fair Poor

Company Name
Street, City, State/Province, Zip/Postal code Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com
© Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by International treaties. IT IS
ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER
PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

Please state briefly what you believe to be his/her greatest strengths and weaknesses (if any):

Strengths

Weaknesses

If you had an opening for which he/she is qualified, would you rehire him/her? Yes No
If no, please state why.

I assure that any information you supply about this applicant will be held in strict confidence. If there is

ever an opportunity for me to reciprocate, I will be pleased to do so. We will need this information as soon

as possible, and thus we would appreciate if you could fax the response to the undersigned at [FAX

NUMBER]. Thank you for your consideration.

Sincerely,

Your name
Your title
(800) 123-4567
youremail@yourcompany.com

Company Name
Street, City, State/Province, Zip/Postal code Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com