**APPLICANT: PLEASE SIGN AND RETURN THIS FORM TO THE HUMAN RESOURCES DEPARTMENT WITH YOUR EMPLOYMENT APPLICATION PACKAGE-DO NOT FORWARD FOR EMPLOYMENT REFERENCE AT THIS TIME**
REFERENCE REQUEST AUTHORIZATION FORM
Dear Employer:
As you will note below, I have applied for employment with York Technical College. I hereby authorize you to give York Technical College any and all information concerning my previous employment and any pertinent information that you might have. I waive the right to review the information.
APPLICANT’S SIGNATURE: _____________________________________________ Date: _____________________
POSITION(S) APPLIED FOR: _________________________________________________________________________
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EMPLOYER REFERENCE COMMENTS
APPLICANT’S NAME: ________________________________________________ SSN: _________________________
POSITION HELD: ____________________________________________________ SALARY: _____________________
PREVIOUS POSITION HELD: ________________________________________________________________________
EMPLOYMENT FROM: _____________ TO _____________ ELIGIBLE FOR RE-EMPLOYMENT ( ) YES ( ) NO
IF NOT, WHY? _____________________________________________________________________________________
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PLEASE RATE APPLICANT ON THE FOLLOWING CHARACTERISTICS: |
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EXCELLENT |
GOOD |
FAIR |
POOR |
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Ability to perform assigned tasks (qualifications for the job) |
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Quality of work (Extent to which work was accomplished) |
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Quantity of work (Amount of work completed on time) |
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Work habits (Productive use of time and equipment; demonstrates initiative) |
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Attendance: |
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Relationship with people (Attitude displayed toward co-workers and supervisors) |
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Overall evaluation of applicant |
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Reason applicant left your company/agency: ______________________________________________________________
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Comments, if any: ___________________________________________________________________________________
Signed by: ____________________________________________ Position: _____________________________________
Organization: Telephone Number _________________
York Technical College is an Equal Opportunity Employer.