Reference Form
EEPL/IV/HRA/F-9
CURRENT EMPLOYER: Employee Id: From (mm/yy): To (mm/yy):
Street Address: Employer’s Fax No.:
Phone No.:
City: State: Country: Postal Code:
Job Title: Reason for Leaving:
Employment Status:(Please check the relevant Supervisor’s Details:
box)
Full Time Name:
Contract /Through Outsourcing Agency
Title:
Outsourcing Agency Details:
Name:
Phone No.:
Address:
E-mail id:
Tel No.:
(Preferably official)
HR Manager’s Details:
Name:
Description of Duties:
Phone No.:
E-mail id:
(Preferably official)
EMPLOYMENT RECORD CONTINUED:
EMPLOYER 2: Employee Id: From (mm/yy): To (mm/yy):
Street Address: Employer’s Fax No.:
Phone No.:
City: State: Country: Postal Code:
Job Title: Reason for Leaving:
Employment Status:(Please check the relevant Supervisor’s Details:
box)
Name:
Full Time
Title:
Contract /Through Outsourcing Agency
Phone No.:
Outsourcing Agency Details: E-mail id:
Name: (Preferably official)
Address: HR Manager’s Details:
Tel No.: Name:
Description of Duties: Phone No.:
E-mail id:
(Preferably official)
PROFESSIONAL REFERENCES:
PARTICULARS REFERENCE 1 REFERENCE 2 REFERENCE 3
NAME
Relationship
/Association Type
Organization
(name of the
company)
Designation/Position
Landline No.
Mobile No.
Email Address