Prior Employment
Reference Check
Revised: 2/23/12
Applicant’s name: Today’s date:
Your name and title:
Name of company (if applicable):
How long have you known employee and in what capacity? (Direct supervisor, co-worker, etc.??)
Confirm dates of employment:
Please rate this individual in the following areas on a scale from 1 to 10 with 10 being an
exceptional employee and 1 being completely unsatisfactory.
Quality of work:
Attention to detail:
Ability to take or follow directions:
Ability to accept correction or criticism:
Initiative:
Reliability:
Can you describe this person’s experience working as a member of a team?
Did you evaluate (candidate’s name) performance? If so, can you speak to his/her strong and weak
points? What was noted as needing improvement during this performance review?
Ability to deal with an unhappy client/customer/co-worker:
***Is this person eligible for rehire? If no, why not?
***Please do not ask direct questions regarding use of leave. You can ask about a person’s reliability and
dependability. Does this person complete work in a timely manner? Were you able to count on this
person to meet deadlines efficiently?
Signature of person performing Reference Check Date
