Reference Check

Section I: Applicant Information

___________________________
Last Name

__________________________
First Name

_________________________________________________________________
Position title
College/Org and Department/Unit

Section II: Reference Contacted

____________ ______________
________________
Person Contacted
Phone Number

___________________________
Employer/Organization

____________________________
___________________________
Position title of person contacted
Candidate
Relationship to candidate:
Academic other

Length of Association to

Supervisor

Co-Worker

Describe: ______________________
1. What kind of duties and responsibilities were assigned to the
candidate? Did he or she complete them satisfactorily?
Task
Level Of satisfaction (Good - Average
Poor)

2. What level of supervision did they require?

Little or no
Occasional
supervision
Supervision
Answer & Rationale:

3. How fast do they adapt, learn and develop?

Fast
Average
Answer & Rationale:

Excessive
Supervision

Slow

4. Where would the candidate struggle?

-

5. How did the candidate interact in the workplace?

a. How would you describe him?

Professionalism (Good - Average

Friendliness (Good - Average Poor)

Poor)

Interpersonal Skills (Good - Average

Team work (Good - Average Poor)

Poor)

6. Do you remember a time the candidate took initiative?

Answer & Rationale:

Work Ethics (Good - Average Poor)

Initiative (Good - Average Poor)

Dependability (Good - Average Poor)

Engagement (Good - Average Poor)

7. If you had the option would you hire the candidate again?
b. Why or why not?
Answer:

8. Are there any inconsistencies in the answers between the

candidate and their reference? If (Yes): Mention why?

Conducted by:
Name: _______________________
_________________________________

Date:

Position and Department:

___________________________________________