REFERENCE CHECK TEMPLATE WITH CHECKLIST

CANDIDATE NAME	POSITION SOUGHT	CHECK PERFORMED BY	DATE OF REFERENCE CHECK	IS INFO PROVIDED ACCURATE?	ARE DATES PROVIDED ACCURATE?
REFERENCE NAME	REFERENCE ORGANIZATION	RELATIONSHIP TO CANDIDATE	REFERENCE PHONE	EMPLOYMENT START DATE	EMPLOYMENT END DATE
REASON FOR SEPARATION	SEPARATION VOLUNTARY?	ELIGIBLE FOR REHIRE?	POSITION HELD	SALARY
NATURE OF CANDIDATE'S JOB
CHECKLIST: RATE CANDIDATE BASED UPON THE FOLLOWING AREAS poor, fair, good, very good, excellent, N/A
CHARACTER	COMPETENCE in relation to employment, only	SERVICE
Honesty	Knowledge	Service to Others
Integrity	Job Skills	Ability to Collaborate
Response to Correction	Work Quality	Ability to Function in Team
Ability to Mentor	Work Quantity	Initiative
Trustworthiness	Ability to Learn	Dependability
Work Ethic	Judgement	Attendance
Communication	Punctuality
CHARACTER | Additional Comments	COMPETENCE | Additional Comments	SERVICE | Additional Comments
WERE ANY DISCIPLINARY ACTIONS TAKEN? PLEASE CLARIFY.	WERE THERE ANY PERFORMANCE ISSUES? PLEASE CLARIFY.	ADDITIONAL COMMENTS
DEFINE THE STRONG POINTS OF THE CANDIDATE.	DEFINE ANY WEAKNESSES OF THE CANDIDATE.

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