CRITICAL DIFFERENCE INC.
1501 N. 9th Ave. Pensacola, Fl. 32503 (850) 477-1234
EMPLOYMENT / CHARACTER REFERENCE
The person listed below desires to work with C.D.I. as an individual contractor. The State
requires at least two employment references. We would appreciate your answers to the questions
listed below.
Applicant's Name ________________________________________________
Social Security Number __________________________________________
In your employ from ____________________ to _____________________
"I the undersigned, authorize you to release any information
pertaining to my work, skills, or experience to C.D.I."
Applicant's Signature ___________________________________________
Please evaluate the following:
Above Needs
Average Good Fair Improvement
Quality of Work -________-________-________-__________
Attitude and Cooperation -________-________-________-__________
Dependable and Punctual -________-________-________-__________
Personal appearance -________-________-________-__________
Is the applicant eligible for rehire? Yes__________ No__________
Facility ________________________________________________________
Evaluator __________________________________ Date _______________
Name and Title Please Print
Address
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e-mail
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