Telephone Reference Check Form

Reference Check Form

Please fill out this form to complete the telephone reference check. Inform the reference that all information is kept confidential and is not shared with the candidate.
"Hello [name]. My name is [your name] and I'm calling from Servaus Home Care. [Candidate name] provided your contact details for a professional reference. Is now a bad time to answer a few questions to verify their employment?"
Candidate Name*

First NameLast Name
Company Name*
Position Held*
Employment Start Date*

MonthDayYear
Date
Employment End Date*

MonthDayYear
Date
Position applied for*
Reference Name*

First NameLast Name
Job Title*
Reference Phone Number*
Please enter a valid phone number.
Reference Email
example@example.com
How long have you known the candidate?*
What is/was your relationship with the candidate?*

SupervisorCoworker/Equal PositionSubordinate/Direct ReportOwner/C-level
Please rate the candidate's performance on a scale of 1-5 (1 being poor, 5 being satisfactory)*
Would you rehire the candidate?*

YesNoRefused to answer
Is the candidate dependable?*

YesNoRefused to answer
Are you willing to provide any additional comments or feedback?
Should be Empty: