TELEPHONE REFERENCE CHECK FORM

CANDIDATE NAME	POSITION SOUGHT	CHECK PERFORMED BY	DATE OF REFERENCE CHECK
REFERENCE NAME	REFERENCE ORGANIZATION	RELATIONSHIP TO APPLICANT	REFERENCE PHONE
EMPLOYMENT START DATE	EMPLOYMENT END DATE	POSITION HELD	SALARY
REASON FOR SEPARATION	SEPARATION VOLUNTARY?	ELIGIBLE FOR REHIRE?
NATURE OF APPLICANT'S JOB
RATE CANDIDATE BASED UPON THE FOLLOWING AREAS poor, fair, good, very good, excellent, N/A
Responds to Supervision	Ability to Follow Instructions
Attendance and Punctuality	Quality of Work
Dependability	Quantity of Work
Ability to Assume Responsibility	Adaptability
COMMENTS REGARDING RATINGS
WERE ANY DISCIPLINARY ACTIONS TAKEN? PLEASE CLARIFY.
WERE THERE ANY PERFORMANCE ISSUES? PLEASE CLARIFY.
DEFINE THE STRONG POINTS OF THE CANDIDATE.
DEFINE ANY WEAKNESSES OF THE CANDIDATE.
ADDITIONAL COMMENTS

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