REFERENCE CHECK FORM

Applicant’s Name Dates Employed

Referee’s Company Name Final Position Held

Did you directly
Referee’s Name Supervise?
Referee’s Phone
Referee’s Position/Title Number

On the Job Performance

Please describe his/her overall work
performance and attitude
Strengths – example of a work activity
displaying strength.
Weaknesses – example where the
weakness became apparent
Was the candidate aware of this
weakness and has there been any effort
to improve in this area?
On a scale of 1-5 (1 being poor and 5 being excellent) how would you rate the
candidate’s following skills
Leadership 1 2 3 4 5
Problem Solving 1 2 3 4 5
Initiative 1 2 3 4 5
Team Work 1 2 3 4 5
Communication 1 2 3 4 5
Ability to work under pressure 1 2 3 4 5
Ability to take constructive criticism 1 2 3 4 5
Ability to work unsupervised 1 2 3 4 5
Technical Skills 1 2 3 4 5
Punctuality / Attendance 1 2 3 4 5

Any issue during tenure He was well behaved

(Ethics, Integrity, Credibility & Reputation)

Attitude Towards:-
Supervisors
Pears
Subordinates
Development Areas?
Reason for Leaving? Personal

Would you re-hire this person? Yes No no

Checked By:
Date: