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Print Form Verification of Employment History and Credentials Background Verification Please complete the following questions below and submit to your Fiscal Officer. Copies of notes from the reference checks will be maintained permanently in the supervisory file. the internet search were resolved to my satisfaction. By my signature below I acknowledge completion of verification of employment history and credentials as explained in the above. These questions must be answered before a salary recommendation will be made. If you have questions on this process please contact your Fiscal Officer or HR Representative. Candidate Name Please list the name s and title s of person s completing this background verification I certify that the employment history of this candidate was verified* The employment history includes dates of employment position held and company name for at least two positions held. Breaks in employment history have been explained to my satisfaction* institutions and degrees. I certify that if a license is required for this position the license is in good standing and documentation will be forwared to HR if the candidate is hired* I certify that professional employment references have been checked for this candidate. Checking references includes speaking with the most recent supervisor and two other professional references. Signature 1 Date Please send to your Fiscal Officer at HB 6045 to begin the process of determining a salary recommendation for this position* PLEASE NOTE You are not to offer a position to any candidate prior to submitting this form and receiving a salary recommendation from your Fiscal Officer. These questions must be answered before a salary recommendation will be made. If you have questions on this process please contact your Fiscal Officer or HR Representative. Candidate Name Please list the name s and title s of person s completing this background verification I certify that the employment history of this candidate was verified* The employment history includes dates of employment position held and company name for at least two positions held. Candidate Name Please list the name s and title s of person s completing this background verification I certify that the employment history of this candidate was verified* The employment history includes dates of employment position held and company name for at least two positions held. Breaks in employment history have been explained to my satisfaction* institutions and degrees. I certify that if a license is required for this position the license is in good standing and documentation will be forwared to HR if the candidate is hired* I certify that professional employment references have been checked for this candidate. Breaks in employment history have been explained to my satisfaction* institutions and degrees. I certify that if a license is required for this position the license is in good standing and documentation will be forwared to HR if the candidate is hired* I certify that professional employment references have been checked for this candidate. Checking references includes speaking with the most recent supervisor and two other professional references.

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