The University of Texas at Tyler
Reference Check Form
Date: _____/_____/_____
Name of person talked to: ________________________________________________________
His/Her position: _______________________________________________________________
Company Name and Address: ____________________________________________________
Phone Number: ________________________________________________________________
My name is: _______________________________________________________with UT Tyler
I am calling about ___________________________________;
(Applicant’s Name)
Are you acquainted with him/her? Yes No
He/She states employment with your organization from: ____/____/_____ to ____/____/_____
Are those dates correct? Yes No
What was the nature of his/her work? ______________________________________________
Is there anything that UT Tyler should know about this person that would be of benefit to him/her
or us?
_____________________________________________________________________________
Why did he/she leave your organization? ____________________________________________
Would you be willing to rehire this person? ___________________________________________
Did they get along with their associates? ____________________________________________
What about their morals and honesty? ______________________________________________
Do you have any general comments about this person? ________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signed: ____________________________________
Revised 3/2018