Reference check form draft

Name: *

Position applied for: *


Name *

Position *

Phone number mobile: *

Phone number landline: *

Organisation *


My name is <your name> and I'm calling to conduct a reference check for <name of candidate> who is being considered for a position with Cara. Your details have been provided to me by <candidate name>. The reference will take no longer than ten minutes is this a good time for you?


In accordance with the Privacy Act, we wish to inform you that the information collected may be shared with personnel of Cara, and the candidate may also lodge a request to our Privacy Officer for access to this information. Based on the above are you happy to proceed?


What is the nature of your relationship with the candidate? *

In what capacity is/was the applicant employed by your organisation? *

Did you supervise the candidate directly? *

If you didn't supervise the candidate directly what was your working relationship with them?

How long did the candidate work with you? *

What were the key tasks of their role during this time? *

Why did they leave the organisation? *

Have you had any areas of concern? *

How would you rate reliability attendance? *

How would you rate professionalism? *


Please rate the following areas on a scale of 1-5 with 1 being well below expectations and 5 being well above expectations *

12345
Communication Skills
Customer person centred focus
Internal Collaboration and team work
Ability to work under pressure
Resilience
Ability to work under minimal supervision
Problem solving
Ability to learn, retain and apply information
Commitment and loyalty
Empathy

Based on the information above please supply detailed information for extreme responses


Please rate the following areas between 1-5 where 1 is well below expectations and 5 is well above expecatations *

12345
How well did the respond to feedback?
Did they achieve key performance outcomes?
Did they contribute to any tasks outside of their role?
Did they adapt well to their role?
Did they adapt well to change?

Based on the information above please supply detailed information for extreme responses


Based on the reference check you have provided would you recommend them to us and would you re-employ them? *


Thank you for your time today


Name of Recruitment Officer: *