Reference Check

Reference Form

Recruiter

First Name

Last Name

Current Title

Phone

Email Address

Candidate First Name

Candidate Middle Name

Candidate Last Name

Name of Company/Hospital Facility

Position Candidate Held

Your Title at Above Company

Approximate Start Date of Candidate's Employment

Approximate End Date of Candidate's Employment

What was your relationship with the applicant?

Please briefly describe the applicants responsibilities.

Work Ethics Work Ethics Very Satisfied Satisfied Somewhat Satisfied Not Satisfied

Relationship with Peers and Management Relationship with Peers and Management Very Satisfied Satisfied Somewhat Satisfied Not Satisfied

Attendance Attendance Very Satisfied Satisfied Somewhat Satisfied Not Satisfied

Overall Performance Overall Performance Very Satisfied Satisfied Somewhat Satisfied Not Satisfied

Candidate's Strengths

Areas of Needed Development

Reasons Candidate Left Position

Would you recommend this applicant for hire or re-hire?

Please fill out every field of the form. You will see a thank you message upon sucessful submission of the form.

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