CRITICAL DIFFERENCE INC.
      1501 N. 9th Ave.  Pensacola, Fl. 32503 (850) 477-1234
   
                EMPLOYMENT / CHARACTER REFERENCE

           The person listed below desires to work with C.D.I. as an individual contractor. The State
requires at least two employment references. We would appreciate your answers to the questions
listed below.                 

Applicant's Name ________________________________________________

Social Security Number __________________________________________

In your employ from ____________________ to _____________________

"I the undersigned, authorize you to release any information
pertaining to my work, skills, or experience to C.D.I."  


Applicant's Signature ___________________________________________
                                                            

Please evaluate the following:
                         Above                       Needs  
                        Average   Good     Fair   Improvement

Quality of Work            -________-________-________-__________

Attitude and Cooperation   -________-________-________-__________

Dependable and Punctual    -________-________-________-__________

Personal appearance        -________-________-________-__________

Is the applicant eligible for rehire?  Yes__________  No__________

Facility ________________________________________________________

Evaluator __________________________________ Date _______________
                         Name and Title Please Print

Address

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e-mail
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