Reference Check Authorization & Verification
   

Candidate Name
Position/Title Applying for
  
1st Reference
Name
Relationship (i.e. Supervisor, Colleague, Co-worker, Associate)
Phone #   - Day                                     - Evening
                    (Area Code)                                                                                                     (Area Code)
Email address:
  
2nd Reference
Name
Relationship (i.e. Supervisor, Colleague, Co-worker, Associate)
Phone #   - Day                                     - Evening
                    (Area Code)                                                                                                  (Area Code)
Email address:
    
3rd 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


 

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