REFERENCE CHECK FORM

Applicant Name:

Referee’s Name: Company where you worked with applicant:

Your Title/Position: Phone Number:

Are you also in-charge with HR matters (employee records?) Yes/No:

If not, kindly give HR Manager name and email:

What was the applicant’s title/position:

Dates of employment:

Salary:

What were the applicant’s major job duties?

How would you evaluate the applicant’s work quality and quantity (productivity)?

How would you evaluate the applicant’s work habits such as attendance, punctuality, dependability, conduct and observance of work rules?

What was the applicant’s reason for leaving?

Would you rehire the applicant?

Section to probe further about specific job-related experience and skills, knowledge and abilities such as: communication, supervision, financial, analytical, contract and grants administration, customer service, etc.

___________________________ ___________________________ Name/ Signature Date: