Intern Reference Check Form
Please provide structured feedback about the intern candidate based on your professional experience.
Reference Provider's Full Name
*
First Name
Last Name
Reference Provider's Email Address
*
example@example.com
Reference Provider's Organization
*
Reference Provider's Job Title
*
Intern Candidate's Full Name
*
First Name
Last Name
Your relationship to the intern
*
Direct Supervisor
Team Lead
Colleague
Mentor
Other
Duration of your professional relationship with the intern
*
Please Select
Less than 3 months
3-6 months
6-12 months
More than 1 year
Intern's start date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Intern's end date (or expected end date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate the intern’s overall performance?
*
Excellent
Good
Satisfactory
Needs Improvement
Evaluate the intern on the following professional qualities.
*
Rows
Excellent
Good
Satisfactory
Needs Improvement
Work Ethic
1
2
3
4
Communication Skills
5
6
7
8
Teamwork
9
10
11
12
Problem Solving
13
14
15
16
Initiative
17
18
19
20
Please describe the intern’s key strengths.
Please describe any areas where the intern could improve.
Would you recommend this intern for future opportunities?
*
Strongly Recommend
Recommend
Recommend with Reservations
Do Not Recommend
I confirm that the information provided is accurate to the best of my knowledge.
*
Yes, I confirm
Submit Reference
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