1. Your Email (required)
2. Candidate
3. Company where employed together
4. Candidate Job Title
5. Candidate Employment Period
6. Your Name
7. Your Position
8. Your length of time with the company
9. Relationship with applicant (can be all) SupervisorCo-WorkerSubordinate
10.How long have you known the applicant?
11. Do you socialize with the applicant away from work?
12. Have you worked with the applicant at any other place of employment? 13. How is the applicant as a spouse/parent/significant other?
14.Would you trust the applicant with confidential matters? If no, please explain.
15. Is the applicant honest, dependable, and highly motivated? If no, please explain.
16. Has the applicant ever been reprimanded, disciplined, or counseled for any reason? If yes, please explain.
17. Has the applicant ever had his salary garnished?
18. Has the applicant ever abused sick leave or been late to work? If yes, please explain.
19. Has the applicant ever filled any type of claim against the company?
20. Is the applicant financially stable? If no, please explain.
21. Has the applicant ever committed any criminal activity to include alcohol or drug related crimes? If yes, please explain.
22. Has the applicant ever displayed any negative personality traits? If yes, please explain.
23. Does the applicant care about people and the welfare of others? If no, please explain.
24. Has the applicant expressed any signs of bias or prejudice towards others? If yes, please explain.
25. Does the applicant lose his/her temper easily? If yes, please explain.
26. Has the applicant ever been involved in any verbal or physical confrontations with anyone? If yes, please explain.
27. Does the applicant accept constructive criticism? If no, please explain.
28. Has the applicant ever displayed any prejudices or dislikes toward other people? If yes, please explain.
29. Is the applicant able to work with all types of people, regardless of background or skills? If no, please explain.
30. Does the applicant handle disputes in the least offensive manner possible? If no, please explain.
31. Is the applicant able to make decisions under stress? If no, please explain.
32. Does the applicant respect authority? If no, please explain.
33. Is the applicant able to perform multiple functions at once? If no, please explain.
34. Is the applicant able to work with minimum supervision? If no, please explain.
35. Does the applicant keep a positive attitude and always act inspired? If no, please explain.
36. Can the applicant be assertive when necessary and is he or she able to take command of many situations? If no, please explain.
37. Is the applicant willing to work as a team member or leader when asked? If no, please explain.
38. Is the application loyal to the organization and has he or she ever attempted to take advantage of any situation? If no, please explain.
39. Does the applicant draw upon life experiences to deal with situations? If no, please explain.
40. Does the applicant think before acting? If no, please explain.
41. What are the applicants greatest strengths?
42. What area does the applicant need to improve upon?
43. What reason did the applicant give for leaving your employment?
44. Is the applicant eligible for re-hire?
45. Would you recommend the applicant for this position?
46. Adaptability ExcellentAbove AverageAverageBelow AveragePoorNot Observed
47. Tolerance for stress ExcellentAbove AverageAverageBelow AveragePoorNot Observed
48. Tolerance for unpleasant work environment ExcellentAbove AverageAverageBelow AveragePoorNot Observed
49. Attitude ExcellentAbove AverageAverageBelow AveragePoorNot Observed
50. Teamwork ExcellentAbove AverageAverageBelow AveragePoorNot Observed
51. Initiative ExcellentAbove AverageAverageBelow AveragePoorNot Observed
52. Leadership skills ExcellentAbove AverageAverageBelow AveragePoorNot Observed
53. Judgment/Common sense ExcellentAbove AverageAverageBelow AveragePoorNot Observed
54. Motivation ExcellentAbove AverageAverageBelow AveragePoorNot Observed
55. Maturity ExcellentAbove AverageAverageBelow AveragePoorNot Observed
56. Interpersonal sensitivity ExcellentAbove AverageAverageBelow AveragePoorNot Observed
57. Ability to get along with others ExcellentAbove AverageAverageBelow AveragePoorNot Observed
58. Communication skills ExcellentAbove AverageAverageBelow AveragePoorNot Observed
59. Emotional control ExcellentAbove AverageAverageBelow AveragePoorNot Observed
60. Dependability ExcellentAbove AverageAverageBelow AveragePoorNot Observed
61. Productivity ExcellentAbove AverageAverageBelow AveragePoorNot Observed
62. Control of temper and emotions ExcellentAbove AverageAverageBelow AveragePoorNot Observed
63. Desires for self-improvement ExcellentAbove AverageAverageBelow AveragePoorNot Observed
64. Honesty/Integrity/Credibility ExcellentAbove AverageAverageBelow AveragePoorNot Observed
65. Completion of work on time ExcellentAbove AverageAverageBelow AveragePoorNot Observed
66. Accuracy/Thoroughness of work ExcellentAbove AverageAverageBelow AveragePoorNot Observed
67. Observance of rules/regulations ExcellentAbove AverageAverageBelow AveragePoorNot Observed
68. Ability to accept instruction ExcellentAbove AverageAverageBelow AveragePoorNot Observed
69. Getting along with supervisors/employees ExcellentAbove AverageAverageBelow AveragePoorNot Observed
70. Performance with minimum instruction ExcellentAbove AverageAverageBelow AveragePoorNot Observed
71. Learning ability ExcellentAbove AverageAverageBelow AveragePoorNot Observed
72. Observational skills ExcellentAbove AverageAverageBelow AveragePoorNot Observed
73. Willingness to confront problems ExcellentAbove AverageAverageBelow AveragePoorNot Observed
74. Interest in people ExcellentAbove AverageAverageBelow AveragePoorNot Observed
75. Appearance ExcellentAbove AverageAverageBelow AveragePoorNot Observed
76. Additional comments Verify Form Is Accurate
