Fillable Printable Blank Employee Reference Check Form
Fillable Printable Blank Employee Reference Check Form
Blank Employee Reference Check Form
Reference Check Template [month/year] Page 1 of 2
[insert organisation name/logo]
Employee Reference Check Form
Name of Applicant:
Person Contacted:
Company:
Position/Title: Phone:
Relationship to applicant:
1. How long has it been since you last spoke with the applicant? (Were you aware they
had put you down as a referee for this application?)
2. What were the dates of his/her employment with you?
3. What was the nature of his/her job? (Describe position applied for - Do you think they
would suit this sort of role)
4. How would you describe his/her performance in comparison with other people?
5. Why did he/she leave your company?
[insert organisation name] Reference Check Form Page 2 of 2
6. Would you re-employ?
7. What are his/her strong points and limitations?
8. How did he/she get along with other people?
9 Please rate the following on a scale of 1-to-10: (1=very poor, 10 = exceptional)
Score
Comment
a) attendance
1
2
3
4
5
6
7
8
9
10
b) dependability
1
2
3
4
5
6
7
8
9
10
c) ability to take on
responsibility
1
2
3
4
5
6
7
8
9
10
d) conflict resolution
1
2
3
4
5
6
7
8
9
10
e) potential for
advancement
1
2
3
4
5
6
7
8
9
10
f) degree of supervision
needed
1
2
3
4
5
6
7
8
9
10
g) overall attitude
1
2
3
4
5
6
7
8
9
10
10. Is there anything else of significance which may impact their performance within
[insert organisation name] if they are successful in the role?
Reference checked by: Date:
