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Generic Employment Experience Verification Form
Applicant Name:_______________________________________________________________________SSN #_____________
Position Applied For:_____________________________________________________________________Req. # ___________
Employer:______________________________________________________________________________________________
Name of Person Contacted:_____________________________________________________________________________
Relationship to Applicant: ( Supervisor ( Co-Worker ( Other (explain:)
Contact Date:______________________________________________________Time:_____________________________
Verify the following from the Employment Application. Use the Comments/Explanations section to explain “"No" answers.
| | | | |
| |VERIFIED | | |
|ITEM TO BE | | |COMMENTS/EXPLANATIONS |
|VERIFIED | | | |
| | | | |
| |YES |NO | |
| | | | |
|Title | | | |
| | | | |
|Dates of | | | |
|Employment | | | |
| | | | |
|Full-Time or | | | |
|P/T (# of hours) | | | |
| | | | |
|Start and | | | |
|Final Salary | | | |
| | | | |
|Supervisory | | | |
|Responsibility | | | |
| | | | |
|Job Duties | | | |
| | | | |
|Reason for | | | |
|Leaving | | | |
OPTIONAL QUESTIONS:
Was overall performance satisfactory? (Yes ( No (If No, explain:)
Would you rehire? ( Yes ( No (If No, explain:)
Do you have any additional comments or recommendations regarding this individual?
Employment History
Verification completed by: ___________________________________________________________________________________________
Printed Name Signature Date
................
................
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