Reference Check Form
Please describe the main responsibilities/type of work the candidate did while working
for you.
Why did
the candidate leave their position?
Using poor, satisfactory, good, or excellent as a scale, please rate the candidate on the
following items:
Abil
ity to learn new tasks
Work independently
Dependability
Trustworthiness
Initiative
Punctuality/attendance
Time management and
Teamwork
Relating to peers/st
udents
Written skills
Verbal skills
organizational skills
Leadership skills
Adaptability to change
Quality of work
Do you have any comments for the competencies above?
Describe the candidate’s ability to make sound and timely decisions.
_
Comment on the candidate’s ability to cope in a diverse and complex work environment.
What areas could the candidate improve upon?
Was the candidate the subject of any disciplinary action or legal proceedings? If yes,
please briefly describe the circumstances and the outcome.
Would you rehire this person? If no, why not?
Is there anything else you would like to add?
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Print Name
_________________
Date