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What information is needed for an accurate background check? By far the two most important pieces of information are a correct Date of Birth and correctly spelled First and Last Name. What is your name? -------------------------------------- What is your date of birth? -------------------------------------- What is your gender? -------------------------------------- What is your mailing address? -------------------------------------- What was your mailing address from birth until now? -------------------------------------- What is your contact information including current mailing address, telephone, e-mail, and any other details, and person to contact in case of emergency? -------------------------------------- What years did you go to high school? -------------------------------------- What years did you go to college? -------------------------------------- Where did you go to high school? -------------------------------------- Where did you go to college? -------------------------------------- What subjects did you study? -------------------------------------- What state have your lived in most of your life? -------------------------------------- What are your assets? -------------------------------------- What are the locations of your assets? -------------------------------------- Did you have these assets in 1980? -------------------------------------- What were your assets in 1980? -------------------------------------- What are your assets in 2013? -------------------------------------- How did you accumulate your assets after 1980? -------------------------------------- What are the assets of his relatives and friends? -------------------------------------- Where are they located? -------------------------------------- What does a typical background check reveal? -------------------------------------- What background checks give the best results? -------------------------------------- Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation? -------------------------------------- Yes No Have you ever pleaded guilty, been found guilty or been convicted of any criminal offense other than a minor traffic violation? -------------------------------------- (If “YES,” attach detailed explanation.)* YES NO Have you ever been discharged from a job? -------------------------------------- Layoff/downsizing does not apply. YES NO (If “YES,” attach detailed explanation.) Did you complete this application yourself? -------------------------------------- __ Yes __ No How did you hear about this job opening? -------------------------------------- Do you supervise other employees? -------------------------------------- Is your position considered full-time? -------------------------------------- Yes No How many hours do you work per week? -------------------------------------- Are you willing to work hours other than 8-5? -------------------------------------- Yes No What days are you unable to work? -------------------------------------- Are you at least 17 years of age? -------------------------------------- Yes No Do you speak a language other than English? -------------------------------------- (If required for this position) Yes No If yes, what language(s) do you speak? -------------------------------------- Have you used any other names? -------------------------------------- Have you received a written warning, been officially reprimanded, suspended, or disciplined for misconduct in the workplace? -------------------------------------- Do you have another job? -------------------------------------- Yes No What type of work are you looking for? -------------------------------------- Part-time Full-time Regular Temporary Here are further guidelines. STANDARD REFERENCE CHECK APPLICANT NAME: ______________________________________________ REFERENCE CHECK WITH: _______________________________________ (1=very good, 5 = poor) 1. What were his/her responsibilities/duties? 2. Was the assigned work accomplished correctly? 1 2 3 4 5 3. Was the work accomplished in a timely manner? 1 2 3 4 5 4. Does he/she work well on own? 1 2 3 4 5 5. How did he/she get along with supervisors? 1 2 3 4 5 Co-workers? 1 2 3 4 5 Subordinates? 1 2 3 4 5 6. How was his/her attendance? 1 2 3 4 5 7. Did he/she have a problem with tardiness? 1 2 3 4 5 8. How was his/her attitude toward work? 1 2 3 4 5 9. Why did he/she leave? 10. Would you characterize him/her as a hard worker? 1 2 3 4 5 11. Would you rehire him/her? Yes No (why) 12. Is there anything we haven’t covered that you would like to mention? Total Reference Rating: QUESTIONS FOR REFERENCE CHECKS Non-exempt 1. How well, and in what capacity, do you know the candidate? 2. What were the candidate’s dates of employment? 3. Is this a person you would hire if you had an open position? (Or, in other words: Is the candidate eligible for rehire?) 4. How would you describe the candidate’s work habits? 5. How much supervision does/did the candidate require? 6. How well does the candidate work, and interact, with people? (Supervisors, subordinates, peers, customers/clients) 7. Why is the candidate interested in other employment? 8. How would you rate the candidate’s punctuality and attendance patterns? 9. What were the candidate’s major accomplishments? 10. How would you describe the candidate’s work habits? 11. How would you describe the candidate’s oral and written communication skills? 12. How effectively does/did the candidate use his/her time? 13. What are the candidate’s work weaknesses? 14. Would you consider this individual to be honest? 15. Is this individual a team player? 16. How structured an environment would you say this individual needs to reach maximum potential? 17. Please comment on this person’s response to constructive criticism. 18. Does this individual typically adhere strictly to job duties, or does he/she assume responsibilities beyond the basic, written job description? 19. How much do outside influences play a role in this person’s job performance? 20. How does this individual handle interruptions, breaks in routine, and last- minute changes? 21. How would you rate this person’s commitment to project completion? 22. How would you grade this person’s capacity for analytical thinking and problem solving? 23. Does this individual need close supervision to excel, or does he/she take more of an autonomous, independent approach to her/his work? 24. How global of a perspective does he/she have? Do you see him/her eventually making the transition from a tactical and operational career path to the strategic level necessary for a career in senior management? 25. How would you grade this individual’s listening skills? 26. How effective is the candidate at delivering bad news? 27. Will he/she typically assume responsibility for things gone wrong? 28. In terms of this individual’s energy level, how would you grade his/her capacity for hustle? 29. How does this individual approach taking action without getting prior approval? 30. Is this person’s natural inclination to report to someone else for sign-off, or does she/he operate better with independent responsibility and authority? 31. Is this individual inclined to maintain smooth and amicable relations at all costs, or is she/he more likely to show his/her teeth when faced with adversity? 32. Since none of us is perfect at everything we do, please describe some of the candidate’s shortcomings. 33. When there was a particularly urgent assignment, what steps did the candidate take to get it done on time? Exempt Level 1. How well, and in what capacity, do you know the candidate? 2. What were the candidate’s dates of employment? 3. Is this a person you would hire if you had an open position? (Or, in other words: Is the candidate eligible for rehire? Why don’t you try to persuade this person to stay?) 4. What are his/her leadership (or “value added”) strengths? 5. What were his/her leadership opportunities, if any? 6. Please provide an example to illustrate the candidate’s experience in the following areas, if applicable. a. Ability to work effectively with individuals at all levels, including government entities b. Skills in ability to creatively solve problems c. Specific skills in area of specificity d. Success in securing sponsored program funding 7. How would you describe the candidate’s oral and written communication skills? 8. Would you consider this individual to be honest? 9. Please comment on this person’s response to constructive criticism. 10. How much do outside influences play a role in this person’s job performance? 11. How would you grade this person’s capacity for analytical thinking and problem solving? 12. How global of a perspective does he/she have? Do you see him/her eventually making the transition from a tactical and operational career path to the strategic level necessary for a career in senior management? 13. How effective is the candidate at delivering bad news? 14. Will he/she typically assume responsibility for things gone wrong? 15. Please grade the individual’s capacity for initiative and taking action. Does he/she have a tendency to get bogged down in “analysis paralysis?” 16. Is this candidate’s management style more autocratic and paternalistic or is it geared toward a more participative and consensus-building approach? 17. How effective is this person at orchestrating a corporate ensemble of functional areas? 18. Please address the candidate’s ability to cope with the significant pressures associated with senior management. 19. How does this individual deal with disciplining or dismissing employees? Have he/she ever delayed in dealing with this situation? 20. Does the candidate stay open to all sides of an argument before reaching a decision, or does he/she get personally involved in conflicts? 21. Since none us is perfect at everything we do, please describe some of the candidate’s shortcomings. 22. Have you seen the candidate’s current resume? Let me read you the part that describes his/her job with your organization. (Stop at each significant point, and ask the reference for a comment.) 23. Who referred the candidate to your company? (It could have been a relative or a customer or client.) SUMMARY – (This section should be completed after the reference check.) What was the reference’s reception to the call? a. Friendly b. Lukewarm c. Cool d. Hostile Your evaluation of the reference: a. Knowledge
2. Vague 3. Insufficient
2. Holding back 3. Would only give basic information
2. Biased toward the candidate 3. Biased against the candidate |