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APPLICANT REFERENCE CHECK FORM
Instructions
• Where possible please provide specific behavioural examples of the applicant
• Please be honest and true to yourself when answering the relevant questions.
• Where not applicable please mark as “N/A”
Name of applicant:
National ID card number:
Designation of the applicant:
Referee: (Name)
(Job Title)
(Organisation)
(Contact no.)
(Email address)
In what capacity do you know the
applicant?
Duration employed with your
organisation:
Attendance, Punctuality & Work Attitude
of applicant:
Applicant’s main job
responsibilities:
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Mode of separation from your resignation termination
organization (if applicable)
dismissal post abolishment (lay-off)
end of assignment
Other (please specify) :
Rate the applicant’s level of
performance on a scale of 1 being
RATE: _______________
lowest to 5 being highest:
What are the qualities or attributes of the applicant that you consider will help their career in the future:
yes no
Comments:
Would you re-hire this
candidate again if given the
opportunity?
DECLARATION
I……………………………………………………. hereby certify the information I have provided in this form is
true, complete, and correct, to the best of my knowledge and belief and that I give my consent to be contacted for
further validation if required by the respected ministry/department/agency.
Signature:………………………………… Date:………………………….
Name: …………………………………
Note to the applicant: Please submit the completed reference check form along with the MIB job application form.
END
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