Reference Check Form

Candidate Name: ___________________________________________________________________

Reference Name: ___________________________________________________________________

Company Name: ___________________________________________________________________

Dates of Employment:      From: _____/_____/_____ To: _____/_____/_____

Position(s) Held: ___________________________________________________________________

Reason for Leaving: _________________________________________________________________

Explain the reason for your call and verify the above information with the supervisor (including the reason for leaving)

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1. Please describe the type of work for which the candidate was responsible.

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2. How would you describe the applicant’s relationships with coworkers, subordinates (if applicable), and with superiors?

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3. Did the candidate have a positive or negative work attitude? Please elaborate.

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4. How would you describe the quantity and quality of output generated by the former employee?

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5. What were his/her strengths on the job?

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6. What were his/her weaknesses on the job?

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7. What is your overall assessment of the candidate?

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8. Would you recommend him/her for this position? Why or why not?

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9. Would this individual be eligible for rehire? Why or why not?

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Other comments?

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