Inline Reference Check

REFERENCE CHECK REQUEST FORM
FAX TO: (519) 927-5371 EMAIL TO: michael@inlinereference.com

Name of Candidate:	_______________________
Current Employer:	_______________________	Position:	_____________________
Hiring Employer:	_______________________	Position:	_____________________

FILE # REFERENCE NAME RELATIONSHIP BUS. PHONE HOME PHONE
(       ) (       )
(       ) (       )
(       ) (       )
(       ) (       )
(       ) (       )
(       ) (       )

( ) REFERENCES ATTACHED

Specific questions or area of inquiry regarding this candidate:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

(       ) Drivers License Abstract (address and License # required)
(       ) Complete credit information research (address and SIN number required)
(       ) Confirm University level qualifications (education history required - please include student # and year of graduation)

Requested By: ________________________________ Position: ________________________________
Company: ________________________________ Telephone: ________________________________
Fax: ________________________________

Thank you for using INLINE.

Candidate Information

PLEASE PRINT CLEARLY

Name:	___________________________
Maiden/Other Name:	___________________________
Social Insurance Number:	___________________________	Date of Birth:	___________________________
Driver License Number:	___________________________	Province:	___________________________
Home Phone Number:	___________________________	Fax Number:	___________________________
Business Number:	___________________________	Email:	___________________________
Home Address:	___________________________
City/Town:	___________________________	Province:	___________________________
Postal Code:	___________________________

References

______________________________________________________________________
Mr./Ms - Name - Relationship
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Home Phone (include area code) - Business Phone (include area code) - Cell Phone (include area code)
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Mr./Ms - Name - Relationship
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Home Phone (include area code) - Business Phone (include area code) - Cell Phone (include area code)
______________________________________________________________________
Mr./Ms - Name - Relationship
______________________________________________________________________
Home Phone (include area code) - Business Phone (include area code) - Cell Phone (include area code)
______________________________________________________________________
Mr./Ms - Name - Relationship
______________________________________________________________________
Home Phone (include area code) - Business Phone (include area code) - Cell Phone (include area code)
______________________________________________________________________
Mr./Ms - Name - Relationship
______________________________________________________________________
Home Phone (include area code) - Business Phone (include area code) - Cell Phone (include area code)

Academic Degrees/Professional Licenses

PLEASE PRINT CLEARLY

______________________________________________________________________
Designation - Institution - Location
______________________________________________________________________
Year of Accreditation - Student/Member Number
______________________________________________________________________
Designation - Institution - Location
______________________________________________________________________
Year of Accreditation - Student/Member Number
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Designation - Institution - Location
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Year of Accreditation - Student/Member Number
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Designation - Institution - Location
______________________________________________________________________
Year of Accreditation - Student/Member Number

Employment History

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Month/Yr - Month/Yr - Company Name - Contact Name
______________________________________________________________________
Contact Phone Number - Position
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Month/Yr - Month/Yr - Company Name - Contact Name
______________________________________________________________________
Contact Phone Number - Position
______________________________________________________________________
Month/Yr - Month/Yr - Company Name - Contact Name
______________________________________________________________________
Contact Phone Number - Position
______________________________________________________________________
Month/Yr - Month/Yr - Company Name - Contact Name
______________________________________________________________________
Contact Phone Number - Position
______________________________________________________________________
Month/Yr - Month/Yr - Company Name - Contact Name
______________________________________________________________________
Contact Phone Number - Position

Release Form

Applicant Identification and Authorization Form

Request to Collect Personal Information

To Whom It May Concern:

I have applied to _____________________ for employment. Part of the hiring process is an investigation of the information I have provided. An authorized agent conducts the investigations. Therefore, at this time, and until informed in writing to the contrary, I hereby authorize and direct the release to _________________ and/or its authorized agent any information concerning: employment, education, credit, driving record, criminal record and/or any other information relevant to my employment at _________________________________.

I hereby declare that to the best of my knowledge the information provided both verbally, on my resume and on this authorization form is complete and accurate, and I understand that employment will be contingent on _________________ satisfaction of the investigation of the background.

Yes No
Are you legally eligible to work in Canada? ( ) ( )
Have you ever been convicted of a criminal offence for which a pardon has not been granted? ( ) ( )

	Yes	No
Are you legally eligible to work in Canada?	( )	( )
Have you ever been convicted of a criminal offence for which a pardon has not been granted?	( )	( )

Candidate

Name (Print) _________________________________________________________

Signature ___________________________ Date ____________________________

Witness