References Page Reference Check Form Reference Information Being Requested On:Applicants Name: First Middle Last Employer Information:This reference information furnished by:PhoneEmailDate Completed:Please imput as dd/mm/yyyy Company Name: Representatives's Name: Representative's Title: Representatives Phone Number: Representatives Email Address: Applicant Information:Employment Dates:e.g April 2021 – January 2022 Job Title: Reason for Leavng: Major Job Duties:Did the Candidate successfully carry out their duties?YesNoMet job requirements in terms of quality of work?YesNoCooperated with fellow employees & supervisors?YesNoWas the applicant punctual?YesNoWas the applicant absent more than 10 days (except vacation) in the last year of employment?YesNoIf Yes please explain.Would you re-hire this person?YesNoIf No, Why?How would you rate this person for:Honesty & Integrity Excellent Very Good Good Fairly Good Poor Accuracy & Speed of Work Excellent Very Good Good Fairly Good Poor Flexibility & Adaptability Excellent Very Good Good Fairly Good Poor Are there any additional comments you would like to make?SignaturePlease upload your signature hereAccepted file types: jpg, jpeg, png, gif.Consent(Required) I give my permission to divulge this reference to a third party.