PAST EMPLOYMENT VERIFICATION FORM

PAST EMPLOYMENT VERIFICATION FORM

TICO LOGISTICS LLC 2 RAVINIA DR. SUITE 500 ATLANTA GA 30346 TEL 404-916-8426 FAX 1888-916-8426
DATE

MonthDayYearHourMinutesAM/PM Option
To whom it may concern:

The applicant below is being considered for employment with our company
APPLICANT NAME

First NameMiddle NameLast Name
SOCIAL SECURITY NUMBER
DATE OF BIRTH

MonthDayYear
AS A
NAME OF PAST EMPLOYER_____________________________________

Application for Authorization

I hereby authorize the above individual, Company, or Institution to furnish TICO LOGISTICS LLC with any information It may have concerning be which is on record or otherwise, and do hereby release the above individual, Company, or Institution and all individual connected therewith, including Tico Logistics LLC from any and liability whatsoever that might otherwise be incurred in furnishing such information.

Signature of Applicant _____________________________________________________________

                                 RECORD OF EMPLOYMENT

Date of Employment: _____________________________________________________________

Position held:____________________________________________________________________

Reason employment ended:________________________________________________________

PLEASE RATE THE APPLICANT IN EACH OF THE FOLLOWING AREAS

JOB SKILLS           EXCELLENT     GOOD      AVERAGE      BELOW AVERAGE     POOR

INITIATIVE            EXCELLENT     GOOD      AVERAGE      BELOW AVERAGE     POOR

ATTENDANCE         EXCELLENT     GOOD      AVERAGE      BELOW AVERAGE     POOR

CONDUCT              EXCELLENT     GOOD      AVERAGE      BELOW AVERAGE     POOR

WOULD YOU REHIRE APPLICANT?  _____YES  _____NO

_____________________________________________________________________________________

SIGNATURE                                            TITTLE                                                               DATE
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