Inquiry to Past Employers – Questionaire



  1. Is employment record with your company correct as stated above? Yes No
  2. What kind(s) of work did he/she do?
  3. Did he/she have custody of money or valuables? Yes No
    Were accounts properly kept? Yes No
  4. Any record of salary garnishments?
  5. If employed as a driver, specify equipment driven:
  6. Number of accidents:
    Number preventable:
  7. Was his /her driver’s license ever suspended or revoked? Yes No
  8. Reason for leaving your employ? (Discharged, Laid off ,Resigned)
  9. Was his/her general conduct satisfactory? Yes No Other:
  10. Is he/she qualified for the position he/she is seeking? Yes No Other:
  11. Would you re-employ? Yes No Other:
  12. Any remarks with regard to question 1-11 above?

For: (Name of Company)
By: (Signature of person supplying information)


(Detach here for your files)

You are hereby authorized to give to the (future employer) all information regarding my services, character and conduct while in your employ, and you are released from any and all liability which may result from furnishing such information.

Signed:(former employee)


Attached Letter

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