The individual named above has applied for employment with Building Bridges Developmental and Community Services, Inc. Please respond candidly to the request for information listed below and return your written response via fax to: 501-676-0697.
The consent and Release is intended to comply with 11-3-204 of the Arkansas Code, a law providing current and former employers with protection for providing job information about current or former employees to prospective employees.
Date and duration of Employement:
Current or last job description and duties:
The details of the applicant's last written performance evaluation prepared prior to the date of applicant signed this consent:
Attendance history (excluding any qualifying leave under FMLA)
Results of drug and/or alcohol tests administered within the last year:
Was his/her separtation from employment voluntary or involuntary:
What was the reason the applicant's separation from employment:
Is this applicant eligible for re-hire? YES NO NO (per company policy)
Current of past employer's signature, title and date: