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REFERENCE CHECK FORM

Name

Position applied for

Previous employer

Contact details

Person spoken to

Designation

Relationship to the applicant

Position applicant held

Duties

Employed from

Employed to

Reason for leaving

Salary & Benefits

Competencies to be followed up
(refer to the Job specification and
include specific competencies eg.
Team work, problem-solving
ability etc)

Strengths

Developmental areas

General comments

Would you re-employ the person?

Reference taken by

Designation

Date

Brisbane • Cape Town • Johannesburg • Pittsburgh • Irvine • London • Mexico City • Shanghai
Directors: GM Leask, KJ Whelan, PD Whelan, Prof. NHB Faull, J Vaughan-Jones, J Mulcahy

Unit 304, 3rd Floor, Foyer 2, Tel: +27 21 555 3610


Colosseum Building, Fax: +27 21 555 0922
Competitive Capabilities International (Pty) Ltd. Reg. No.
Cnr. Century Boulevard & Century Way, Century E-mail: info@ccitracc.com
1964/003315/07
City, 7446 www.ccitracc.com

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