Reference Check
Your Name
First Name
Last Name
Candidate Name (Person reference is for)
First Name
Last Name
Your Phone Number
-
Area Code
Phone Number
Name of Company/Hospital Facility
Position Candidate Held
Your Title at above Company
Approximate Date of Candidate's Employment (If known)
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Month
-
Day
Year
Date Picker Icon
1
-
Month
-
Day
Year
Date Picker Icon
Questions and Details:
What was your relationship with the applicant?
Please briefly describe the applicant’s responsibilities.
Please rate the Candidate’s effectiveness in the areas of:
Very Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
Work Ethics
2
3
4
5
Relationship with peers/managers
6
7
8
9
Attendance
10
11
12
13
Overall Performance
14
15
16
17
Strengths:
Areas of needed development:
Reason Candidate Left Position:
Would you recommend this applicant for hire or re-hire?
Please Select
Yes
No
Submit
Should be Empty: