VOE | M&D Industries, Inc.

Request for Verification of Employment & Reference

Please assist us in our decision by completing the questions below. Your prompt assistance is greatly appreciated. Should you have any questions, please do not hesitate to contact our office at (936) 372-9801. All information provided will be held in strict confidence. Thank you for your time & assistance!

First Name

Last Name

Please verify his/her dates of employment with your company:

Please verify his/her position with your company:

Please verify his/her responsiblities while employed with your company:

Please verify his/her ending rate of pay:

To your knowledge, did the employee work well with their co-workers/managment?

Yes

If no, please elaborate, if possible.

Please list any other information you may feel is relevant in assisting us with our decision:

Is candidate eligible for re-hire with your company?

Yes

Your Signature

TODAYS DATE:

OPTIONAL - Upload

Thank you again for your help!!

Your response has been emailed directly to the HR department.