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About FMU

Employer Reference Request

Please complete the following reference form. The form includes 10 items. A descriptive response including examples, when possible, is appreciated. You may, however, use a scale of 1 to 10 with 1= lowest and 10=highest ratings for characteristics.

* Required

Errors

Applicant's Name:

Position Held:

Previous Positions Held:

Employment Date From:

Employment Date To:

Eligible for rehire:

Yes

Did he/she give proper notice?

Yes

Would you rehire the applicant in the same position?

Yes

If no, why would you not rehire him/her?

Reason for departure:

Identify any strengths/weaknesses you saw in the employee:

Dependability?

Reliability?

Attendance?

Attitude?

Honesty?

Initiative?

Judgement?

Ability to work under pressure?

Relationships with others?

Additional Comments, if any:

First Name

Last Name

Email Address

Company:

Title:

Phone Number
( ) - ext.

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