Reference Check Form

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REFERENCE CHECK FORM

Name of the employee:

Former employer organization name:

Person & title of person providing:

Reference info:

Dates of employment: Start: End: .

Job Title in previous organization:

His/ Her Salary details:

Reasons for Leaving:

Was his/her performance acceptable?

Yes No

Where there any issues with tardiness or absenteeism?

Yes No

Did he/she get along well with management and co-workers?

Yes No

Is he/she a good team member?

Yes No

Would you Re-hire him/her if opportunity arises? YES/NO (If no please explain)

Yes No

Comments:

Verified By

Name: Designation: Email:

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