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