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:
___________________________________________