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:

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: