Date:

To:

Subject:

Dear Sir/Madam:

The individual identified above is being evaluated for employment and has signed our employment application authorising this inquiry. We would appreciate a statement of your experiences with this person when employed by your company. Please provide the information requested on the bottom oi this letter and return to us in the enclosed self-addressed stamped envelope at your earliest convenience.

Your reply will be held in strict confidence. We sincerely appreciate your cooperation and will gladly reciprocate.

Sincerely,

_________________________

Name and Position

CONFIDENTIAL

Applicant Name:

Address:

Name of Former Company:

Address:

Employed From: ______________ To ______________

General Work Record:

Signed: ________________________

Name and Title