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Reference Check Form

Name(Required)

First Last

Title/Role

Employer

Email Address(Required)

Would you like a copy

Yes

Name of Individual asked you to be their reference(Required)

How long have you known the candidate?

Less than 6 months

6–12 months

1–2 years

3–5 years

5+ years

Relationship Type(Required)

Family/Friend

Professional

Work relationship(Required)

Supervisor of candidate

Candidate supervised me

Peer/colleague

Worked cross-functionally (not direct reporting)

Would you rehire or work with this person again?(Required)

Yes

Not applicable

Prefer not to say

Please rate the candidate using the scale below: 1 = Needs Improvement | 3 = Meets Expectations | 5 = Exceptional | N/A = Not Observed

Reliability & follow-through(Required)

Communication(Required)

Professionalism & boundaries(Required)

Handling feedback & coaching(Required)

Respectful and inclusive conduct toward others(Required)

Please use the space below to share any additional information that would be helpful in evaluating the candidate.

Confirmation(Required)

“I confirm the information provided is true and accurate to the best of my knowledge.”

Signature(Required)

Date

Month

Day

Year