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©
September 3, 2020
C
o Contact Name
p Address
y Address2
City, State/Province
r Zip/Postal Code
i
g
h
t OBJECT: REQUEST FOR REFERENCE

E Dear [CONTACT NAME],

n  
v The above-named individual has applied for a position with our company and indicates previous
i employment with your firm. The information requested below will help us to evaluate the applicant. We will
hold your comments in strict confidence. We thank you for your cooperation.
s
i
o Sincerely,
n

C
o Your name
r Your title
p (800) 123-4567
o youremail@yourcompany.com
r
a
t
i Please indicate Department:
o Position with your firm:
n Employed From Through
. Final Salary $ Social Insurance Number
Please rate the applicant, (good/fair/poor), on the basis of his employment with you:
2
Ability Conduct Attitude
0
Efficiency Attendance Punctuality
0
What was the reason for termination?
2
.
Would you re-hire? . If not, give reason:
A  
l
l
Signature and Title
r
i
Company Name
Street, City, State/Province, Zip/Postal code Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com