PRE-EMPLOYMENT REFERENCE CHECK VIA PHONE (TYPE B)
Applicant: ________________________
Position: _________________________
Company Contacted: ______________________ Phone: _________________
Name of Company Representative:
___________________________
Title of Company Representative:
____________________________
Dates of Employment - From: _______________ To:
_____________
Salary Information:
Regular Pay: ______________ Overtime Pay: __________________
Bonus: ____________________ Shift Differential: _______________
Date of last wage increase:
__________________________________
What was your relationship with the applicant? _____________________________
___________________________________________________________________
What were the applicant's job title and duties? ______________________________
____________________________________________________________________
___________________________________________________________________
How long did you supervise this employee? ________________
How would you compare this employee to others doing
similar work and responsibilities?
___________________________________________________________________
___________________________________________________________________
Strong Points: ________________________________________________________
____________________________________________________________________
____________________________________________________________________
Areas for Improvement:
_________________________________________________ _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
How would you rate this applicant's ability on a scale
of 1 to 5 (1 being the lowest) regarding the following:
Attention to Detail _____
Comment
_______________________________
Learn _____ Comment
_______________________________
Follow Directions _____
Comment
_______________________________
Accept Responsibility _____ Comment _______________________________
Follow Through _____
Comment
_______________________________
Initiate _____
Comment
_______________________________
Supervisory Duties:
_____________________________________________________
_____________________________________________________________________
Supervisory Ability: _____________________________________________________
_____________________________________________________________________
Leadership Potential:
____________________________________________________
_____________________________________________________________________
Attendance / Punctuality:
_________________________________________________
_____________________________________________________________________
Ability to Work With Others:
______________________________________________
______________________________________________________________________
Reason for Leaving:
_____________________________________________________
______________________________________________________________________
Would you Rehire:
_____________________________________________________
_____________________________________________________________________
Other Comments:
_______________________________________________________
______________________________________________________________________
References Checked by:
__________________________________________________
Date: __________________
