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Candidate Personal Reference Questionnaire
Candidate Personal Reference Questionnaire
"
*
" indicates required fields
Step
1
of
2
50%
Company
This field is for validation purposes and should be left unchanged.
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.
Personal Reference
Enter details about the person you a providing a reference for
Candidate Name
*
First
Last
What is your relationship to the Candidate?
*
How long have you known this candidate?
*
Years
Months
Your Details
What is your name?
*
First
Last
Phone Number
*
Email
*
Personal Traits
Please rate the Candidate on the following personal traits that they possess from Poor, Fair, Good, or Excellent. Any rating of Poor or Excellent will require further explanation and/or information.
Dependability
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Keeping Commitments
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Confidence
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Honesty / Integrity / Work Ethic
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Personable
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Ethical
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Common Sense / Judgment
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Compassionate
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Listens to Others
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Decisive
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Self-Motivated
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Resourceful
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Patient
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Handling of Criticism
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Handle Problems / Tasks in Stressful Situations
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Judgement / Decision Making
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
How does the Candidate deal with any changes in their life?
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
How does the Candidate deal with difficult problems or emergencies?
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Communication Skills
Please rate the applicant on their communication skills
Verbal
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Written
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Personal
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Phone
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Relationships/ Interpersonal Skills
Please rate the applicant on their relationships/ interpersonal skills.
Co-workers
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Supervisors
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Public
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Family / Friends
*
Excellent
Good
Fair
Poor
Unknown
Additional Information
*
You provided a 'fair' response, which indicates 'average' or just 'above average', can you expand your response further?
Diversity / Sensitivity
Display Bias Based On
Race / Ethnicity
*
Never
Little
Some
Always
Unknown
Additional Information
*
Gender
*
Never
Little
Some
Always
Unknown
Additional Information
*
Religious Beliefs
*
Never
Little
Some
Always
Unknown
Additional Information
*
Sexual Orientation
*
Never
Little
Some
Always
Unknown
Additional Information
*
Age
*
Never
Little
Some
Always
Unknown
Additional Information
*
General Questions
Please provide further details to any “no” answer
Can the Candidate be assertive and confront a problem when necessary?
*
Yes
No
Additional Information
*
Do you feel the Candidate will be effective in a job where helping other people is a key responsibility?
*
Yes
No
Additional Information
*
Can the Candidate function in a team environment?
*
Yes
No
Additional Information
*
Can the Candidate work with person of a different cultural background or of the opposite sex?
*
Yes
No
Additional Information
*
Would you trust this Candidate with your own personal safety or that of your family?
*
Yes
No
Additional Information
*
Would this Candidate be a good fit for a Public Safety position?
*
Yes
No
Additional Information
*
Do you consider the Candidate to be a person of integrity and/or honest person?
*
Yes
No
Additional Information
*
Do you have complete trust in this Candidate?
*
Yes
No
Additional Information
*
General Questions
Please provide further details to any “yes” answer
Are you aware of any current or past alcohol abuse issues with Candidate??
*
Yes
No
Additional Information
*
Are you aware of any current or past illegal drug use with Candidate?
*
Yes
No
Additional Information
*
Are you aware of any current or past prescription drug abuse with Candidate?
*
Yes
No
Additional Information
*
Have you seen the Candidate lose control of their emotions?
*
Yes
No
Additional Information
*
Have you ever seen or heard of this Candidate doing or saying anything inappropriate?
*
Yes
No
Additional Information
*
Has the Candidate expressed or displayed any bias or prejudice towards others?
*
Yes
No
Additional Information
*
Can you think of any reason why this Candidate should not be offered this job?
*
Yes
No
Additional Information
*
Do you have any information that you would like to discuss directly with the background investigator privately?
*
Yes
No
How and when would you like to be contacted?
*
How do you know this Candidate?
*
Have you known this Candidate to ever serve in the US Military or that of any other country? If yes, please provide known details of service.
*
What terms would you use to describe the Candidate to someone else?
*
What is the Candidate’s strongest character feature?
*
What is the Candidate’s weakest character feature?
*
Who do you consider the Candidate’s “Best Friend(s)” to be? Please provide full name and contact information (if you have it).
Full Name
Phone
Email
Add
Remove
Please provide at least two additional references who know the Candidate. Please provide full name, telephone, and email address.
Full Name
Phone
Email
Add
Remove
Please provide additional information about the Candidate that you feel might be relevant to the background investigation.
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