Appendix 4 – Reference Check Form

1. In what capacity do you know the applicant (immediate supervisor, manager, co-worker, etc.)?

2. Position held/confirmation of employment dates:

3. Nature of job (provide a brief job description):

4. What would you consider to be the applicant’s strengths?

5. Were there specific areas that required improvement?

6. Can you tell me what kind of an employee the applicant was?

7. Could you describe the applicant’s relationship with co-workers, customers, and managers?

8. Do you think that the applicant works better individually or in a group environment?

9. Describe the applicant’s expertise in the field for which he or she is applying:

Please comment on:

• Quantity of work:
• Dependability/reliability:
• Environment required to excel:
• Quality of work:

10. How does the applicant react to stressful situations?

11. What comments or suggestions would you have for the new manager of (applicant’s name)?

12. What is your overall opinion of (applicant’s name)?

13. Can you tell me the reason the applicant left your organization?

14. Would you re-employ the applicant? Yes     No   (If no, why not?)

15. From what you know, would you recommend the applicant for the position applied?

Yes     No   (If no, why not?)

16. Is there anything else you would like to comment on regarding (applicant’s name) employment or job performance?