© 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.

REFERENCE CHECK CONTROL FORM

Applicant Name: Position:

PERSONAL REFERENCES CHECKED:

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Notes:

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Notes:

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Notes:

EMPLOYMENT REFERENCES CHECKED:

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Would you rehire? Reason for termination:

Notes:
© 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.

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Would you rehire? Reason for termination:

Notes:

Name: Relationship:

Address:

Telephone: Date contacted: Method of contact:

Would you rehire? Reason for termination:

Notes:

RECORDS CHECKED:

 School records (Date requested: ) Notes:

 Criminal records (Date requested: ) Notes:

 Driving records (Date requested: ) Notes:

 Credit records (Date requested: ) Notes: