Fillable Printable Noncomplete Employee Reference Check Form
Fillable Printable Noncomplete Employee Reference Check Form
Noncomplete Employee Reference Check Form
Rev. (8-21-2008) Equal Opportunity Employer Page 1 of 3
EMPLOYMENT REFERENCE CHECK FORM
Pre-employment references solicited by the Company are confidential and may not be released to the applicant,
employee or public. Use of this form by departments or managers is optional but the guidelines found in the
Reference Checking policy must be observed. When checking references by mail, attach a copy of the application
signature showing the applicant's authorization to release information to the Company.
REFERENCE INFORMATION BEING REQUESTED ON:
Applicant’s Name:
First
Middle
Last
REQUESTING AGENCY INFORMATION: (To be completed by the hiring department or manager)
Date of Request:
Name of Hiring
Department:
Department Address:
Representative’s Name:
Representative’s Title:
Representative’s Phone:
EMPLOYER INFORMATION:
(To be completed by previous/current employer if by mail; or by hiring department or manager if by phone)
This reference information furnished by:
Phone
Number:
Mail
Address:
Date Completed:
Name of Employer:
Representative’s Name:
Representative’s Title:
Representative’s Phone:
If requested by Mail, please return to the Hiring Department’s or Manager’s address listed above.
Rev. (8-21-2008) Equal Opportunity Employer Page 2 of 3
APPLICANT INFORMATION:
Applicant’s Name:
First
Middle
Last
Employment Dates:
From:
To:
Reason for Leaving:
Major Job Duties:
Special Skills:
Met job requirements in terms of quantity of work?
Exceeded Requirements
Met Requirements
Did Not Meet Requirements
Met job requirements in terms of quality of work?
Exceeded Requirements
Met Requirements
Did Not Meet Requirements
Cooperated with fellow employees and supervisors?
YES
NO
Usually came to work on time?
YES
NO
Absent more than 10 days (except vacation) in the last
year of employment?
YES
NO
If Yes, please explain:
Received an oral or written warning for performance or
conduct in the last year of employment?
YES
NO
If Yes, please explain:
Committed any serious misconduct while on the job?
YES
NO
If Yes, please explain:
Required close supervision?
YES
NO
Rev. (8-21-2008) Equal Opportunity Employer Page 3 of 3
If Yes, please explain:
Would you rehire (or retain) this person?
YES
NO
If no, why?
Additional Comments/Explanations:
The HR-related content of this form was originally produced by The HR Support Center, a strategic resource partner of MidwestHR
Legal Disclaimer: The Reference Check Form is intended for informational purposes only, and does not constitute legal information or advice. This information and all
HR Support Center materials are provided in consultation with federal and state statutes, and do not encompass other regulations that may exist, such as local
ordinances. Transmission of documents or information through the HR Support Center does not create an attorney-client relationship. If you are seeking legal advice,
you are encouraged to consult an attorney.
