Reference Check Template Feb 16

Office for Institutional Equity and Compliance
ReferenceCheckTemplate

SectionI:ApplicantInformation

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LastNameFirstNameMiddleInitial

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PositiontitleCollege/OrgandDepartment/Unit

SectionII:ReferenceContacted

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PersonContactedEmployer/OrganizationPhoneNumber

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Positiontitle ofreferenceLengthofassociationtocandidate

Relationshiptocandidate: □Supervisor□Co-Worker □Academic □OtherDescribe:______

SectionIII:CandidateInformation

Referencemustbeworkrelevantorrelatedtoacademicbackground

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PositiontitlecandidateheldEmployer/Organization Datesofemployment

Identifyyourself,yourinstitution,yourreasonforcallingandthepositionforwhichthecandidateisapplying.If necessary, brieflydescribethe dutiesand responsibilitiesofthepositionthecandidateisseeking.

1. Brieflyprovidethereferencewithasummaryofthecandidate’sstatementofhis/herdutiesintheformer position. Doesthissummaryaccurately reflectthecandidate’sdutiesandresponsibilities?

1. Didyouhaveanopportunitytoobserveandevaluatethecandidate’sperformance? Ifyes,howwould describethecandidate’sworkperformanceinthisposition?

1. Howwouldyoucomparethe workperformanceofthiscandidatewiththatofotherswhohaveheldthesame position?

1. Describethecandidate’sknowledge,skillsandsubject matterexpertise.

1. Whatareascouldthecandidateimproveupon?

1. Pleaseprovideexamplesofthecandidate’sexperiencewithand/orcommitmenttodiversityinthe work/academicenvironment.

1. Describethecandidate’sworkethicinthecontext oftrustworthiness,dependabilityandinitiative.

1. Howwouldyouratethecandidate’swritingandverbalcommunicationskills?

1. Howwouldyouratethecandidate’sinterpersonalcommunicationskills?

1. Howwouldyoudescribethecandidate’srelationswithhis/hercustomers?

1. Howwouldyouratethecandidate’stimemanagement/organizationskills?

1. Describethecandidate’sabilitytomakesoundandtimelydecisions.

1. Describethecandidate’sadaptabilitytochange?

1. Ifknown, whydidthecandidateleaveyouremploy?

1. Isthecandidateeligibleforrehire? Ifno,canyousharethereasonswhynot?

1. Isthereadditionalinformationthatyouwouldliketoprovidethatwouldbepertinentinconsideringthiscandidate foremployment?

SectionIV:RequiredSignature

______Signature ofPersonCheckingReferences Date

IEC10152010