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Employment Reference Questionnaire

Employment Reference Questionnaire


Employer Reference Questionnaire

"*" indicates required fields

Step 1 of 2

50%
Thank you for taking the time to complete our questionnaire.   We rely upon well-informed individuals like you to assist us in the selection of personnel who are qualified for public service and who will maintain high standards of performance in the public safety profession.

Employer/Supervisor Reference

Enter details about the person you a providing a reference for
Candidate Name*
MM slash DD slash YYYY
MM slash DD slash YYYY

Company Details

Address*

Your Contact Details

Please fill in your contact information
What is your name?*

Work Performance

Please rate the applicant on their work performance using the options Excellent, Good, Fair, Poor, or Unknown. Any rating of Poor or Excellent will require further explanation and/or information.
Punctuality*
Attendance*
Appearance / Physical Fitness*
Dependability*
Overall Attitude/ Work Ethic*
Problem Solving Skills*
Resourcefulness*
Adapts to Change/ Willingness to Learn*
Attention to Detail*
Decision Making Skills*
Following Directions*
Take Charge When Needed*
Handle Problems/ Tasks in Stressful Situations*
Maintain Emotional Control*
Performing complex tasks under stressful conditions*
Working with the critically injured / ill*
Self-Motivated/ Takes Initiative*
Critical decision making under stressful conditions*
Judgment / Common Sense*
Handling Sleep Deprivation/ Shift Work*
Responds to Constructive Criticism*
Personal Accountability for Actions*

Degree of Supervision Needed*

Communication Skills

Please rate the applicant on their communication skills
Verbal*
Written*
Radio*

Relationships/ Interpersonal Skills

Please rate the applicant on their relationships/ interpersonal skills.
Co-workers*
Supervisors*
Public*
Work as a team member*

Character

Please rate the applicant on their character.
Honesty/ Integrity/ Ethics*
Trustworthy*
Follow through on Commitments*

Diversity / Sensitivity

Display Bias Based On
Race / Ethnicity*
Gender*
Religious Beliefs*
Sexual Orientation*
Age*

General Questions

Please provide further details to any “no” answer

General Questions

Please provide further details to any “yes” answer

Please provide at least two additional references who know the Candidate. Please provide full name, telephone, and email address.*
Full Name
Phone
Email
 
This field is for validation purposes and should be left unchanged.

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