Appendix 4 – Reference Check Form
| Name of applicant: | |
| Employer: | Phone: |
| Name of contact and position: | Email: |
- In what capacity do you know the applicant (immediate supervisor, manager, co-worker, etc.)?
- Position held/confirmation of employment dates:
- Nature of job (provide a brief job description):
- What would you consider to be the applicant’s strengths?
- Were there specific areas that required improvement?
- Can you tell me what kind of an employee the applicant was?
- Could you describe the applicant’s relationship with co-workers, customers, and managers?
- Do you think that the applicant works better individually or in a group environment?
- Describe the applicant’s expertise in the field for which he or she is applying:
- Please comment on:
- Quantity of work:
- Dependability/reliability:
- Environment required to excel:
- Quality of work:
- How does the applicant react to stressful situations?
- What comments or suggestions would you have for the new manager of (applicant’s name)?
- What is your overall opinion of (applicant’s name)?
- Can you tell me the reason the applicant left your organization?
- Would you re-employ the applicant? (If no, why not?)
- From what you know, would you recommend the applicant for the position applied? (If no, why not?)
- Is there anything else you would like to comment on regarding (applicant’s name) employment or job performance?
| Date of reference check: | Completed by: |
