Employee Reference Check Form

(only applicable for whom this will be his / her first employment.)

Note: provide references with at least three years acquaintance other then relatives
Reference 1 1
Name: __________________________________ Designation: _________________________________

Organization: _____________________________ Department: _________________________________

Address: _____________________________________________________________________________

Relationship with Applicant: ____________ _________________________________________________

Telephone (office): ____________________________ (Home): _________________________________

(Cell): ______________________________ Fax: __________________________________

Reference 2 1
Name: __________________________________ Designation: _________________________________

Organization: _____________________________ Department: _________________________________

Address: _____________________________________________________________________________

Relationship with Applicant: ____________ _________________________________________________

Telephone (office): ____________________________ (Home): _________________________________

(Cell): ______________________________ Fax: __________________________________

Reference 3 1
Name: __________________________________ Designation: _________________________________

Organization: _____________________________ Department: _________________________________

Address: _____________________________________________________________________________

Relationship with Applicant: ____________ _________________________________________________

Telephone (office): ____________________________ (Home): _________________________________

(Cell): ______________________________ Fax: __________________________________

Authorization / Declaration n
I do hereby authorize Samba Pakistan, to contact directly or through other agency, the persons I have listed above as
reference. I hereby allow persons, I have listed above as reference, to disclose any information they may have
regarding my qualifications for employment, including but not limited to employment dates, description of jobs
performed, salary and wage rates and personal attributes.

Name Signature

Department Cadre & Business Title

Location Date