Reference Check Authorization

GRAMBLING STATE UNIVERSITY Reference Check Authorization & Verification
Candidate Name
Position/Title Applying for
1^st Reference Name
Relationship (i.e. Supervisor, Colleague, Co-worker, Associate)
Phone # - Day - Evening (Area Code) (Area Code)
Email address:

2^nd Reference Name
Relationship (i.e. Supervisor, Colleague, Co-worker, Associate)
Phone # - Day - Evening (Area Code) (Area Code)
Email address:

3^rd Reference Name
Relationship (i.e. Supervisor, Colleague, Co-worker, Associate)
Phone # - Day - Evening (Area Code) (Area Code)
Email address:


____________________________________ Signature	________________________ Date

This is verification that references were checked.
____________________ ___________________________ ___________________ _____________ Unit Head Name Title Signature Date