Name of Reference

Address

Address

City

Country



Date



RE: APPLICANT REFERENCE CHECK



Dear Sir/Madam:



You have been mentioned/identified as a reference for the applicant mentioned below. As part of our employment procedure, and in order to help us make an informed choice, we will appreciate if you take some time out to fill the following questionnaire.



Some parts of the questionnaire have already been completed for your convenience.



Applicant Name:

Vacancy Applied For:

Interviewed By:

Designation:

Interviewer Contact:



Reference Name

Reference Company Name:



1. Are you related by birth or marriage to applicant? Yes (circle any 1 of the two)



1. Are you related by birth or marriage to applicant? Yes (circle any 1 of the two)

2. If yes, please specify relationship with applicant ______________________________________



3. How long have you know the applicant? _____________________________________



Please tick appropriate box (below) indicating your assessment of the above mentioned applicant’s character, conduct, maturity, integrity etc. ( please note: 1 is lowest - 6 is highest )



Low High

- displays self confidence 1 2 3 4 5 6

- has high level of integrity / honesty 1 2 3 4 5 6

- is optimistic, even when facing difficulties 1 2 3 4 5 6

- is proficient in managing relationships 1 2 3 4 5 6

- is able to find common ground and build rapport 1 2 3 4 5 6

- has expertise in building & leading teams 1 2 3 4 5 6

- accepts change readily 1 2 3 4 5 6

- encourages new ideas 1 2 3 4 5 6

- learns from own and others’ mistakes 1 2 3 4 5 6

- sets priorities based on short and long term business needs 1 2 3 4 5 6

- consistently exceeds expectations 1 2 3 4 5 6

- acts promptly and decisively 1 2 3 4 5 6

- is proactive and seeks opportunities 1 2 3 4 5 6

- treats information as a corporate resource 1 2 3 4 5 6

- builds a wide range of contacts across functions / industry 1 2 3 4 5 6

- promotes a win-win environment 1 2 3 4 5 6

- exhibits lateral thinking 1 2 3 4 5 6

- creates or notes patterns from a variety of data 1 2 3 4 5 6

- quickly gets to the heart of the problem 1 2 3 4 5 6

- identifies sources of conflict and promotes their resolution 1 2 3 4 5 6

- encourages two-way, not just top-down communication 1 2 3 4 5 6

- explains the ‘why’ when communicating decisions 1 2 3 4 5 6

- encourages feedback and criticism 1 2 3 4 5 6

- uses a variety of techniques to gain commitment 1 2 3 4 5 6

- helps achieve clarity while, translating strategy into actions 1 2 3 4 5 6

- is aware of financial and other commercial impacts of decisions 1 2 3 4 5 6

- monitors and responds to the competitive environment 1 2 3 4 5 6

- maintains close contact with customers 1 2 3 4 5 6

- meets commitments made to internal and external customers 1 2 3 4 5 6

- consistently exceeds customer expectations of quality, 1 2 3 4 5 6

time and quantity



Your response to the questionnaire will be treated in the strictest of confidence.



We thank you in advance for your time.



ARUN JADHAV

EXECUTIVE-HR

KSBL

PUNE.