HTML Preview Telephone Reference Check Form page number 1.
Telephone Reference Check Form
Purpose: A reference check is a valuable tool in the recruitment process to verify facts and obtain additional information about the
candidate. All sections should be completed to be considered a valid reference. Indicate N/A if the question is not applicable.
DO NOT CONDUCT A CHECK WITHOUT A COMPLETED APPLICATION FROM PITTSOURCE.
Applicant Name:___________________________
Date of Reference Check:_______________________
Person Checking Reference:______________________
Reference Name:______________________________
Reference Organization:_________________________
Relationship to Applicant: Supervisor Peer Other (Specify)______________________________
Dates of Employment: From ________To__________
Salary:______________________________________
Position(s) Held:
What was the nature of the applicant’s job?
Reason for Separation: Voluntary Involuntary
Give Explanation:
____________________________________________________________________________________________________________
Please rank the candidate based on the following areas:
Responds to Supervision Poor Fair Good Very Good Excellent N/A
Attendance Poor Fair Good Very Good Excellent N/A
Dependability Poor Fair Good Very Good Excellent N/A
Willingness to assume responsibility Poor Fair Good Very Good Excellent N/A
Ability to follow instructions Poor Fair Good Very Good Excellent N/A
Quality of work Poor Fair Good Very Good Excellent N/A
Quantity of work Poor Fair Good Very Good Excellent N/A
__________________________________________________________________________________________________
Additional Questions:
Were there any disciplinary actions? Please explain:
Were there any performance issues? Please explain:
What are the candidate’s strong points?
What are the candidate’s weak points?
If given the opportunity, would you re-employ this individual? Yes No
Any additional comments?