Date: _______________

Dear ___________________

We have received an application for employment from ________________ (name), seeking a position with our firm in the capacity of __________. We understand the applicant was previously employed by your firm.

Accordingly, we would appreciate a reference on the individual, including confirmation of the dates of employment with you, performance evaluation, and reasons for termination.

Please advise whether your reference should be held confidential.

Thank you for your anticipated cooperation.

Very truly,

_______________________________