Verification Of Previous Employment
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1Verification of Previous Employment
INSTRUCTIONS TO APPLICANT
As part of the University of Illinois Hospital & Health Sciences System's hiring process, your previous employment is verified. Listing your most
recent position held first, identify all positions and employers for the last five(5) years. If your last position held was more than five(5) years
ago, list the position last held. If you have not previously worked, write the word NONE in the last position held line.
Applicant Name
Social Security No:
(Please Type)
First
MI
Last Name
xxxxxxxxx
Applicant Address:
Phone:
Street
(xxx) xxx- xxxx
City
State
Zip Code
Previous Employment Information
HR use
Dates of Employment
only
From
To
1. Company Name:
Last Position Held:
Street:
mm/yy
mm/yy
City
State
Zip Code
Phone No
2. Company Name:
Last Position Held:
Street:
mm/yy
mm/yy
City
State
Zip Code
Phone No
3. Company Name:
Last Position Held:
Street:
mm/yy
mm/yy
City
State
Zip Code
Phone No
HR Hiring Coordinator:
PRINT AND MAIL THE COMPLETED RELEASE
INFORMATION ACKNOWLEDGEMENT
FORM TO:
I certify that the information provided in the box above is true and complete.
UIC HR Service Center
I understand that false or misleading information given in my employment
715 S. Wood Street, 4 th Floor, M/C 900
application, interview(s), or on this form will render my application void and
will be just cause for termination of my employment.
Fax: (312) 996-3837
If you are currently employed outside of the University of Illinois, may we
contact your current employer?
For general questions, please call or email:
Yes
No
Phone:(312) 996-7941 or (312) 996-6159
cbcuichr@uillinois.edu
Applicant Signature
Date
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