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Reference Form
Reference Form
Applicant:_________________________________________________________
Position Applied For:________________________________________________
Date of Reference Check:_____________________________________________
Reference name and Title:____________________________________________
Telephone Number:_________________________________________________
Relationship to Applicant: Supervisor____ Co-Worker_____ Professional____
Position Held:
Reason for Separation:
Eligible for Rehire: Yes___________________ No____________________
Poor Fair Good Very Excellent NA
Good
Attendance
Dependability
Quality of Work
Skills/Knowledge
Leadership
Problem-solving
Communication
Teamwork
Attitude
Work
Independently
Follow-through
Customer Service
Is there any reason that you feel this candidate should not be
considered?_________________________________________________________
__________________________________________________________________
__________________________________________________________________
Reference Completed By:______________________________Date:___________