SAMPLE

Telephone Reference Check List

References should be checked after the interview. Name of Applicant______________________________________________ Person Contacted_______________________________________________ City/State_____________________ Company___________________________________________________Telephone #___________________

I would like to erify some of the information !i en to us "y_____________________# who is applyin! for a position with the $epartment of___________________ at %C $a is. Note& 'uestions must "e job related. (esponses should "e documented information. )hat were the dates of his/ her employment with you* )hat was the nature of his/her +o" ,description of duties and responsi"ilities-* $id he/she ha e any super isory responsi"ility* .ow did he/she !et alon! with others* .ow would you descri"e his/her performance* )hat are his/her stron! and weak points* Could you comment on his/her attendance# dependa"ility# a"ility to take on responsi"ility# potential for ad ancement# de!ree of super ision needed# and any difficulties that interfered with his/her work* )hat +o" pro!ress did he/she make* )hy did he/she lea e your company* )ould you rehire him/her* If not# why not* If you e/perienced any difficulties# were they discussed with the employee* )as there impro ement*

Si!nature________________________________________________
(e ised 0/12/12

$ate________________________