Reference Check Form

Name of Applicant:

Person Contacted:

Company:

Position/Title: MANAGER - CUSTOMER ENGAGEMENT Phone: NA

Relationship to applicant: NA

1. Why did he/she leave your company?

PERSONAL REASONS

2. Would you re-employ?

YES

3. What are his/her strong points and limitations?

TEAM MANAGEMENT, CUSTOMER RELATIONS, TOO SOFT ON DIRECT REPORTEES

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4. How did he/she get along with other people?

5. Please rate the following on a scale of 1-to-10: (1=very poor, 10 = exceptional)

Score Comment

a) attendance 1 2 3 4 5 6 7 8 9 10

b) dependability 1 2 3 4 5 6 7 8 9 10

c) ability to take on
1 2 3 4 5 6 7 8 9 10
responsibility
d) conflict resolution 1 2 3 4 5 6 7 8 9 10

e) potential for
1 2 3 4 5 6 7 8 9 10
advancement
f) degree of supervision
1 2 3 4 5 6 7 8 9 10
needed
g) overall attitude 1 2 3 4 5 6 7 8 9 10

6. Is there anything negative about the candidate which may impact their performance?

NA

Reference checked by: Date: 22-07-2022

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