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  • P5 Reference Form

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    natan kinfe
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    This document is a reference check list used by Independent Counselling Enterprises to collect information about a job applicant from previous employers. It requests the reference provider's name and contact details, as well as the applicant's job title, dates of employment, job duties, and ratings from 1-10 on various job skills and comments. It also asks the reference to comment on the applicant's areas of weakness, strength, and whether they would rehire the applicant, along with the reason they left the position.

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    This document is a reference check list used by Independent Counselling Enterprises to collect information about a job applicant from previous employers. It requests the reference provider's name and contact details, as well as the applicant's job title, dates of employment, job duties, and ratings from 1-10 on various job skills and comments. It also asks the reference to comment on the applicant's areas of weakness, strength, and whether they would rehire the applicant, along with the reason they left the position.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Download as doc, pdf, or txt
    9 views1 page

    P5 Reference Form

    Uploaded by

    natan kinfe
    This document is a reference check list used by Independent Counselling Enterprises to collect information about a job applicant from previous employers. It requests the reference provider's name and contact details, as well as the applicant's job title, dates of employment, job duties, and ratings from 1-10 on various job skills and comments. It also asks the reference to comment on the applicant's areas of weakness, strength, and whether they would rehire the applicant, along with the reason they left the position.

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    © All Rights Reserved
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    INDEPENDENT COUNSELLING ENTERPRISES

    REFERENCE CHECK LIST

    Name: _________________________________________

    **Be sure to identify yourself, by name, title, and company when requesting a reference.**

    Reference Name: _______________________Relationship/Position: ____________________________


    To Applicant
    Name of Agency: _____________________________________Telephone #: ______________________
    Date Telephoned: ________/_________/_________
    Day Month Year

    Applicant's Final Position: ________________________


    Employed From: _______________________________ To: ________________________________
    Discrepancy in Employment Dates  Yes  No
    Brief Summary of Job duties/responsibilities: ______________________________________________
    _____________________________________________________________________________________

    Please rate the person on a scale of 1-10 on the following job skills

    Job Skills Rating Comments


    1-10

    Time management (able to meet


    time lines effectively)
    Organizational skills
    Written Documentation (consider
    neatness, accuracy, and
    professionalism)
    Represented agency professionally
    Followed agency policy/procedures
    Acceptance of feedback
    Leadership/Supervisory skills
    (if applicable)
    Attendance
    Comments
    Interpersonal Skills
    Working relationships with co-workers
    Working relationships with supervisors
    Interpersonal communication skills
    Comments
    Client Relationships/Advocacy
    Maintains professional relationships
    with clients
    Able to understand & meet client needs

    Comment on:
    Areas of weakness______________________________________________________________________
    Areas of strength_______________________________________________________________________
    Would you rehire  Yes  No Reason for Leaving __________________________________________

    Signature of ICE Representative: _________________________________________________________

    P5 Updated October 2021

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