Reference Form - Psych Pros

Candidate First Name *

Candidate Last Name *

Candidate Phone *

Reference First Name *

Reference Last Name *

Reference Phone *

Reference Employer *

Reference Title *

Reference Completed By *

Date Completed *

How long have you known the candidate? *

Employment Dates *

What position did he/she have in your organization? *

Give me a brief description of his/her job duties and responsibilities. *

What are three things he/she does best (Strengths)? *

If you believe, as we do, that everyone can improve in certain aspects of their job performance, in what ways can he/she improve their performance over the next five years (Weaknesses)? *

How did he/she perform as a team member? *

How much direction did he/she require from you? *

How did he/she respond to organization or job changes? *

Do you have any reason to question his/her honesty or ethics? *

Do you have any reason to think this person would be a danger to a mental health client? *

Please rate the candidate's performance in the following categories:

Attendance

Reliability

Attitude

Cooperation

Clinical / Work Related Skills

Verbal Communication Skills

Written Communication Skills

Overall Job Performance

Would you work with him/her again? *

If you were to describe this candidate in 25 words or less to an employer, how would you describe them as an employee? *

Is there anything we have not discussed concerning this candidate that you think is important or would like to add? *

PsychPros Candidate Reference Check