Job Classification Number and Title:

Candidate:

Please attach supplemental notes and questions asked of this reference.

Reference contacted (name):

Title:

Company name:

Telephone number:

Employment or volunteer experience as reported by reference:

Job title:

From: To:

What is your relationship to the candidate:

Reason for leaving:

How receptive is the candidate to taking direction:

Describe the candidate’s level of technical expertise:

How well does the candidate internalized new concepts:

Does the candidate followed through on assignments:

Describe his/her ability to organize and present ideas:

How did the candidate’s productivity compare with other in similar positions:

Can you give an example of how the candidate exercised sound judgment in performance of duties:

Describe the candidate’s ability to demonstrate honesty and integrity in their work:

Describe how he/she works under pressure:

How many employees did the he/she supervise:

What were the job titles of the subordinates:

Describe his/her working relationship with their co-workers:

Can you identify areas in which the he/she may need improvement:

Has there been any disciplinary actions with this individual:

Are there any other areas of the candidate’s performance that we should be aware of:

Attendance record:

Eligible for rehire: Yes [ ] No [ ] and Why?

Other comments:

Reference checked by:

Date: