Reference Verification

Name of Employer

Name of person who is verifying employment

Your Title

Address

City

State

Zip

Country

Your Email

Your Telephone Number

Candidate for whom you are verifying employment

Name of the estate He/She/They worked for

Position Held

Did this candidate(s) live-in, live-out, or other?

Did you provide any accommodations? (if applicable)

Did He/She/They keep the living quarters clean?

Period Worked From

Period Worked To

Lists of duties performed

Were there any children in the home?

How many children were there in the home?

What were the ages of the children?

Did He/She/They work well with the children?

Were there any pets in the home?

Did He/She/They do pet care?

How would you rate His/Her/Their work performance?

Did He/She/They have any downside?

Do you know the applicant by any other name?

If yes, please indicate that name here:

Was He/She/They personable:

Did He/She/They go the extra mile:

To your knowledge, was this candidate a smoker?

Did He/She/They work well with other staff if any?

How was His/Her/Their work attendance?

Would you re-hire?

Reason He/She/They left your employ:

Did this applicant give you the required two weeks’ notice? Please answer if applicable.

Did He/She/They leave in good standing?

Do you have any other comments that would help us place this/these candidates?

* I do hereby confirm that I am authorized to verify employment for the above mentioned candidate(s)

* Type the numbers.

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