REFERENCE REQUEST FORM

Please send my reference request to...

Company Name Supervisor

Supervisor Email:

Full Mailing Address:

Telephone Number

For (Applicant)

Applicant's Name Job Title:
Applicant Email:

Tax ID/SS#

I hereby authorize the employer named above to provide any requested information to Excel Staffing Services, Inc. and release them from all liabilities in responding to inquiries in connection with my application.



TO BE COMPLETED BY PREVIOUS EMPLOYER

(Applicants do not fill out this portion.)

Dates of Employment:From To

Position Held:

Reason for Leaving:

Would you rehire?

In placing an application with us for the position of , the above applicant has given you as a reference. It would be appreciated if you will complete this form. Thank you for your help.