Date: __________ Candidate’s Name:
Name of Respondent:
Company Name:
Verification of Candidate’s Title:
Verification of Date’s of Employment:
In what capacity did you know the candidate and for how long? (i.e., manager, supervisor, etc.)
Briefly explain the candidate’s key duties:
If given the opportunity, would you rehire this person?
Please explain:
Would you rehire or be willing to develop him/her for a position with greater responsibilities
and duties?
Please explain:
What specific contributions did he/she make to the collective work ethic of the office?
How would you describe his/her attendance? (i.e., punctual, frequently absent)
How would you describe the candidate’s work and management style? (i.e., team player,
time management, people management skills)
How would you describe his/her ability and motivation to perform the requirements of the job?
(i.e., How does this person deal with pressure, deadlines? What is his/her ability to focus on details)
How would you describe the candidate’s ability to accomplish duties in a timely manner?
Were assignments completed or goals achieved to your company’s satisfaction and standards?
Did the candidate ever engage in any inappropriate conduct or any activity/behavior in which
disciplinary action was necessary?
Please explain:
Do you have any other work related information or comments that you would like to provide?
Completed by:
Signature Date
Reference Check Form - Servant HR 03/11