www.sowela.edu
Employment Verification Form
(Submit three former employers contact information)
The applicant listed below is being considered for employment with SOWELA Technical Community
College and has listed your organization as a former place of employment. In accordance with the release
signed by the applicant below, please provide the information requested and return this form to us via fax to
(337) 491-2135 or via mail to: SOWELA Technical Community College, Attn: Department of Human
Resources, P. O. Box 16950, Lake Charles, LA 70616-6950. Thank you for your cooperation.
Name of Applicant:
Name of Former Employer:
Supervisor: _________________________________________________ Telephone #: ______________________
Applicant’s Authorization
I hereby authorize the above named organization to furnish SOWELA Technical Community College with
any information it may have concerning me which is on record or otherwise, and do hereby release the
above named organization and all individuals connected therewith, from any and all liability whatsoever
that might otherwise be incurred in furnishing such information.
Signature of Applicant: _______________________________________________
For STCC HR staff use only if conducted via telephone:
Record of Employment
Date(s) of Employment: _______________________________________________
Position(s) Held: _____________________________________________________
Reason Employment Ended: ____________________________________________
Employee Eligible for Rehire: Yes No
Please rate the Applicant in each of the following:
Disciplinary Record None Few Excessive Write-ups
Additional Comments: ________________________________________________________________
___________________________________________________________________________________
Person completing check: _______________________________________________
Signature Date
Revised: 11-19-2007
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