REFERENCE CHECK FORM

Applicant Name:
Referees Name:

Company where you worked with

applicant:

Your Title/Position:

Phone Number:

Are you also in-charge with HR

matters (employee records?)
Yes/No:

If not, kindly give HR Manager

name and email:

What was the applicants title/position:

Dates of employment:
Salary:
What were the applicants major job duties?

How would you evaluate the applicants work quality and quantity
(productivity)?

How would you evaluate the applicants work habits such as

attendance, punctuality, dependability, conduct and observance of work
rules?

What was the applicants reason for leaving?

Would you rehire the applicant?

Section to probe further about specific job-related experience and

skills, knowledge and abilities such as: communication, supervision,
financial, analytical, contract and grants administration, customer
service, etc.

___________________________
Name/ Signature
Date:

___________________________