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EMPLOYEE REFERENCE CHECK FORM 12

EMPLOYEE REFERENCE CHECK FORM 12

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Name of the Applicant: Address of: Referee’s Name Company Name:
General Conduct*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Work Performance*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Attitude to Work*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Initiative*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Time management*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Teamwork and Leadership skills*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Attendance (Managing leaves with low absent rates )*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Relationships with: Colleagues:*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
Relationships with: Customers:*
- Excellent
- Good
- Satisfactory
- Below Average
- Poor
If you indicated applicant is “Below Average” or “Poor” for any category please state your reasons below:
Specific dates of employment:(Please use exact dates)
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FROM
DD slash MM slash YYYY
TO
DD slash MM slash YYYY
Nature of work*
Specific duties, responsibilities:*
Reason for leaving employment? If dismissed please supply details:*
Reason for leaving employment? If dismissed please supply details:*
Was the applicant honest and trustworthy at all times?
- Yes
- No
Reason for leaving employment? If dismissed please supply details:
During employment was applicant the subject of a Disciplinary procedure?
- Yes
- No
If yes, please supply full details and outcome
Would you re-employ applicant?
- Yes
- No
If no, please state reasons why?
Do you have any other information you feel would be relevant to an employer?
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