Emergency Responder Reference Check Form
Please complete this form to provide a reference for an emergency responder candidate. Your honest feedback helps us evaluate their suitability for critical response roles.
Reference’s Full Name
*
First Name
Last Name
Reference’s Job Title
*
Organization/Company
*
Reference’s Email Address
*
example@example.com
Reference’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Candidate
*
Please Select
Supervisor
Colleague
Direct Report
Mentor
Other
Candidate’s Role Context
*
How would you rate the candidate’s emergency response qualities?
*
Rows
Excellent
Good
Satisfactory
Needs Improvement
Calmness Under Pressure
1
2
3
4
Decision Making
5
6
7
8
Teamwork
9
10
11
12
Communication
13
14
15
16
Reliability
17
18
19
20
Please provide any additional comments about the candidate’s suitability for emergency response roles.
Do you give permission for us to contact you about this reference?
*
Yes, you may contact me
No, please do not contact me
Submit Reference
Should be Empty: