[Company Name]

Telephone Reference Check Form

Applicant Information
Applicant Name:	Date:
Last	First	M.I.

Position Applied for:
Recruiter Name:

Contact Information
Name of Contact:
Title:	Phone:
Company:
Address:
Street Address	Suite #
City	State	ZIP Code

Reference Comments
Was the applicant an employee of your company?	YES	NO
When?	START DATE:	END DATE:
What was the applicant’s position on the last day of employment?
What were the applicant’s job responsibilities?
What are the applicant’s strengths?
Weaknesses?
How would you characterize the applicant’s problem-solving skills?
How would you characterize the applicant’s technical skills?
Did the applicant work on multiple projects at once? If so, how did he/she handle it?
Please describe a time when the applicant had a conflict with a co-worker. How did he/she handle it?
What was the applicant’s reason for leaving your employ?
Would you rehire this applicant?	YES	NO
Is there anything else you would like to add?
Thank you for your time and assistance.