Human resources
Reference check form template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Preview — US standard
Reference Check Form
| Item | Details |
| --- | --- |
| Candidate | Candidate Name |
| Position applied for | Position Applied For |
| Reference name | Reference Name |
| Reference title and company | Reference Title and Company |
| Reference phone or email | Reference Contact |
| Relationship to candidate | Relationship to Candidate |
| Checked by | Checker Name |
| Date | Check Date |
The candidate authorized this reference check on Authorization Date.
Questions
Ask only job-related questions, and ask every candidate's references the same questions. Do not ask about age, race, religion, national origin, disability, health or medical history, pregnancy, family plans, marital status, genetic information or other protected characteristics. Where state or local law bans questions about pay history or criminal history at this stage, do not ask them.
| Question | Answer |
| --- | --- |
| Dates of employment and job titles | Dates and Titles |
| Main duties | Main Duties |
| Strengths | Strengths |
| Areas for improvement | Areas for Improvement |
| Reliability and attendance (without asking about medical reasons) | Reliability |
| How the candidate worked with others | Teamwork |
| Reason for leaving, if known | Reason for Leaving |
| Eligible for rehire? | Rehire Eligibility |
| Anything else relevant to this role? | Other Comments |
Checker's Notes
Checker Notes
Overall: Positive, Mixed or Concerns
Keep this form confidential and use it only for this hiring decision. If you use a third party to obtain background reports, follow the Fair Credit Reporting Act, including its disclosure, authorization and adverse action requirements.