HR Supervision Verification Form

HR SUPERVISION VERIFICATION FORM

Use this form to document and verify supervisory relationships, periods of supervision, duties performed under supervision, and related employment history. The person completing this form must have direct knowledge of the supervisory relationship described herein and must certify to the accuracy of the information provided.

1. Employee Subject Information

Job Title:    Department:

Work location:

Employment start date:    Employment end date (if applicable):    Current status:

2. Verifier (Supervisor) Information

Department:    Phone:

Relationship to subject:    Period of supervision (from): to

3. Supervision Details (List direct reports and duties)

Direct report 1 — Name:

Supervision dates: from to    FTE percentage:

Direct report 2 — Name:

Supervision dates: from to    FTE percentage:

Were there additional direct reports beyond those listed? Yes No

4. Performance and Conduct (Supervisor assessment)

Overall performance while under supervision (select one): Exceeds Expectations Meets Expectations Needs Improvement Unsatisfactory

5. Employment History (Minimum two employers)

6. Education

Graduation date:

7. Professional References (minimum three)

Phone:    Email:

Phone:    Email:

Phone:    Email:

8. Legal Disclosures and Authorizations

At-Will Employment: If the subject is an employee of this organization, the employment relationship is at-will unless a written agreement signed by authorized management specifies otherwise. Nothing in this verification form alters the at-will nature of employment.

Equal Opportunity: This organization provides equal employment opportunity without regard to protected characteristics. Statements in this form are requested and provided in a non-discriminatory manner for verification and personnel record purposes.

Authorization to Contact and Background Checks: By completing and signing below, the verifier certifies that the verifier has direct knowledge of the facts stated. The verifier further confirms whether the subject has provided written authorization for the employer to release employment information and for HR to conduct reference or background checks as required by organizational policy and applicable law.

Employee authorization on file: Yes No

9. Verifier Certification

I certify under penalty of disciplinary action that the information provided on this form is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in corrective action up to and including termination. I authorize the release of factual employment information to appropriate internal parties for purposes of verification, licensing, credentialing, or investigation as permitted by law and organizational policy.

Signature constitutes acknowledgement that this verification is factual and based on direct knowledge or reliable records maintained by the verifier's department.

Sign Now