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November 13, 2016

Reference name
Address
Address2
City, State/Province
Zip/Postal Code

OBJECT: PERSONAL REFERENCE FOR [APPLICANT] [SOCIAL SECURITY NUMBER]

Dear [REFERENCE NAME],

The above-named individual has applied for employment with our business and has named you as a
reference. In order to make an informed hiring decision, we need to know the applicant's work/educational
history and personal qualifications or fitness for employment. A release permitting you to provide the
following information has been signed by the applicant and a copy is attached. Any information that you
give will be held in the strictest confidence. Please verify by answering the following questions.

How long have you known [APPLICANT]?

What is the nature of your relationship?
Why do you think [APPLICANT] would
be a good choice as a [NAME OF POSITION]?
Do you know of any reasons that could
prevent [APPLICANT] from performing the
functions of the position?
Information furnished by:
Signature:
Date:

Thank you for your cooperation and prompt response.

Sincerely,

Your name
Your title
(800) 123-4567
youremail@yourcompany.com
Company Name
Street, City, State/Province, Zip/Postal code
Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com