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:
Reference Check Template
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:
Reference Check Template
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:
Reference Check Template
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
Reference Check Template
performance?
