Reference Check Template

Requisition #:

Applicant Name:

Date:

Conducted by:

Reference Name:

Reference Phone:

Sample Script:
Hi, My name is _________________ and Im calling to conduct a reference check for (applicant name), who is being considered for the position of
(position title, branch and ministry).
Your name has been provided by (applicant name) as a reference. I would like to first confirm that you have supervised (applicant name), and
also that you are prepared to provide a reference. I will be verifying certain employment information as well as his/her skills, abilities and
competencies that are related to this position.
The reference check will take approximately 20-30 minutes to complete. Is this a good time for you? If not, when is the earliest time possible,
at your convenience, that I can book time with you to continue this conversation?
Briefly explain the responsibilities of the job and the key factors you will be assessing through the reference check
Important to mention: Please note that this reference will be used in the overall evaluation of the applicant and will affect the final rating.
The information you provide can be given to the candidate, in full or part, should it be requested under the Freedom of Information and
Protection of Privacy Act.
Select the competencies, skills and abilities you want to assess using the reference check method. Please review the job
profile/ selection criteria/ interview notes to select the factors you want to assess. You may also use the Sample list of skills,
abilities and competencies in the table below. Please ensure the factors you choose to assess are required for the optimal
job performance.

Sample skills, abilities and competencies (factors) that could be assessed in the reference check. Please choose the
factors that apply to the job.
Sample Skills

Sample Abilities

Sample Competencies

Communication Skills

Ability
work
Ability
Ability
Ability

to multitask and handle high volume of

Problem Solving & Judgement

to meet deadlines
to deal with irate, upset, hostile people
to exercise tact and diplomacy

Holding People Accountable

Leadership
Developing Others

Organizational Skills
Administrative Skills
Computer Application Skills

Reference Check Template

Customer Service Skills
Interpersonal Skills
Records Management Skills

Attention to detail, high level of accuracy

Ability to manage programs/ projects
Ability to lead staff

Teamwork and Cooperation

Service Orientation
Fostering Trust

General Questions (not to be rated)

I have a few general questions to ask,
followed by questions related to job
specific factors and then overall factors.

Notes:

1. In what capacity was the applicant

employed by your company / Ministry /
Branch?
2. What were the dates of employment?
3. Please describe the applicants key
responsibilities during this time.

Rating guide: Gather and collect all information from the referee and complete the rating after the call. Reference
check can be Pass/ Fail or Scored. Below is a sample scoring grid as well as descriptors for Pass/Fail. Do not ask the
reference to provide a score.
Rating:
Poor- Unacceptable 0-1
FAIL

Significantly below
criteria required for
successful job
performance

No answer or
inappropriate answer

Demonstrates counterproductive behaviours

that have negative
outcomes or
consequences

Weak - Less than acceptable

2
FAIL

Insufficient for performance

requirements

Generally does not meet

criteria relative to quality
and quantity of behaviour
required for successful job
performance

Does not demonstrate a

sufficient range of skills for
handling of situation

Satisfactory Acceptable
3
PASS

Should be acceptable
for effective
performance

Meets criteria relative

to quality and quantity
of behaviour required
for successful job
performance

Demonstrates a
sufficient range of skills
for handling the

Full performance Very good

4
PASS

More than acceptable for

effective performance

Consistently demonstrates
better than average level of
performance

Requires limited direction in

complex situations

Exceptional 5
PASS

Exceeds expectations in
most to all areas with
superior results

Requires limited direction

in complex situations

Reference Check Template

situation

Job Specific Questions:

In the table below insert the skills, abilities & competencies and corresponding questions you wish to ask. Below are
2 examples of ability statements and corresponding questions. These are samples only and should be replaced with
factors that are specific to the job. To be most effective, include a maximum of 4 to 5 areas to cover.
Question 1:
REPLACE THIS SAMPLE WITH YOUR
OWN QUESTION
Example: Ability to meet deadlines
while managing a high work volume
In this role the position is required to be
very well organized, and able to manage a
full and diverse workload while meeting
deadlines.

Notes:

Please describe ____________s ability to

organize and manage their workload. How
well does ____adapt to changing priorities?
Probing Questions: In what aspects
does candidate excel? In what aspects
could candidate improve? Has this been
discussed with him/her? What
development is underway to achieve this
improvement? How long has he/she been
working on improvement and what is the
progress.

Rating:

Reference Check Template

Question 2:
REPLACE THIS SAMPLE WITH YOUR
OWN QUESTION
Example: Ability to identify, monitor
and assess problems.

Notes:

In this role the position is required to identify,

monitor and assess problems and
determine appropriate course of action.

Please describe _______________s ability to

identify, monitor and assess problems and
determine course of action.
Probing Questions: In what aspects
does candidate excel? In what aspects
could candidate improve? Has this been
discussed with him/her? What
development is underway to achieve this
improvement? How long has he/she been
working on improvement and what is the
progress.
Question 3:
Skill, ability/ competency assessed:
________________

Rating:

Notes:

Insert the question:

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Question 4:
Skill, ability/ competency assessed:
________________

Rating:
Notes:

Insert the question:

Rating:

Overall Performance Questions:

If you have any questions or concerns after completing this section, please contact your Hiring Advisor or contact AskMyHR

Reference Check Template

1. What would you say were ________key
strengths and challenges?
2. Have there been any issues or
performance concerns with this
individual?
If yes, please explain when were these
issues identified? When were they
discussed with the individual? What
development is underway to achieve
improvement? How long has he/she
been working on improvement and
what is the progress/ outcome?

Notes:

Rating:

Reliability Punctuality and Attendance:

4. Did the applicants ability to attend
work on a regular and consistent basis
and when needed ever effect the
operation of the office or their ability to
satisfactorily perform their
responsibilities and duties?
Please explain any concerns/ or
absence patterns. Did you discuss
these issues or concerns with the
individual? If yes, what improvement
have you observed?

Notes:

Rating

Standards of Conduct:

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6. How effective was this individual in
ensuring that their conduct met the
highest standards in matters such as
confidentiality, loyalty, honesty,
integrity, impartiality, workplace
behaviour and conflicts of interest?
If there were any issues or concerns in
this regards, please explain. Did you
discuss these issues or concerns with
the individual? If yes, did improvement
result?

Notes:

Rating:

In closing:
1. Is there anything else of relevance that
I have not asked you that you think I
should know about this individuals
performance at work? Any comments
you wish to add?

Notes:

2. Would you rehire this individual? Why,

or why not?

Notes:

Note: Thank the referee for taking the tame to provide the feedback. Provide your name and number in case they wish to call you back with further information.

Overall Rating Summary

Question and Factor you are assessing

Max
Rating

Score or
Pass/Fail

Question 1.
Question 2.
Question 3:

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Question 4:
Overall Performance:
Reliability
Standards of Conduct

Minimum Pass Mark (if applicable)

Total Score (if applicable) or Overall Pass/ Fail rating

Additional Sample questions for each lead question you can add probing questions such as: In what aspects did the candidate excel? In what
aspects could candidate improve? Has this been discussed with him/her? What development is underway to achieve this improvement? How long has he/she
been working on improvement and what is the progress?

1
2

Teamwork and Cooperation: In this position the successful applicant must be able to work cooperatively as part of a team and support
team decisions. How well did this employee demonstrate this in your organization? Please explain or describe.
Relationship building: Please describe ____________s ability to establish and maintain professional (effective, respectful, collaborative)
liaisons/relationships, with colleagues, clients and supervisor(s).

Communication Skills: Please describe ___________s ability to communicate effectively - both verbally and in writing in a clear, concise
manner (inter-personal, group settings, email, letters/memos, reports, presentation, etc.).

Managing stress/ workload: Please describe ____________s ability to effectively cope with and manage through periods of high workload
and/or workplace stress. What stress management and/or self-care abilities have you observed being demonstrated. What abilities have
you observed with respect to coping with and managing through staff and co-worker stress and challenging behavior?

Leadership/ Management Skills: Please describe ___________s staff leadership ability and provide an example. In what leadership areas
is he/she very effective? What areas of leadership need further development? Describe how he/she addresses and deals with challenging
employees. Provide an example of his/her success in managing employee performance. In what areas of employee coaching and
development is he/she very effective? What effective approaches has he/she demonstrated to develop or improve employee

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performance?