[CTC – HRO – PTPP – Recruitment & Selection – 7.8.
5-c-0 ]
[Reference Check Form – Nov 2025]
Employment Reference Check
Name of Person for which reference is provided: ___________________
Name of Referee: ___________________ Designation of Referee: ___________
Date of Reference: ___________________ Signature of Referee: ___________
Tick the mentioned rating for the recommended person:
Above Not
Professional/personal Out- Satisfactor
Satisfactor Satisfactor Unknown
qualities Standing y
y y
Quality of work
Ability to work with others
Flexibility/adaptability to
change
Punctuality
Communication-oral/written
Attitude
Judgment
Initiative/Leadership
Achievements
Overall Performance
Tick the mentioned rating for employee conduct
Supervisor ☐
1 How do you know the candidate?
Other ☐ (specify):
2 What was the applicant position in your organization?
Was there any harassment or unprofessional misconduct conduct
(Sexual exploitation, sexual abuse or sexual harassment) complaint
3
lodged against the employees by the public or any other employees Yes ☐ No ☐
during the period of employment
Sexual Exploitation ☐
If the answer to question no 3 is positive, please explain the nature and
4 Sexual Abuse ☐
outcome
Sexual Harassment
☐
Was the person engaged in any professional misconduct that ,may pose
5
a risk to the safety of children and vulnerable groups/ adults Yes ☐ No ☐
Sexual Exploitation ☐
If the answer to question no 5 is positive, please explain the nature and
6 Sexual Abuse ☐
outcome
Sexual Harassment
☐
Has any disciplinary action or investigation been taken against the
7
person Yes ☐ No ☐
8 If given the opportunity, would you rehire this candidate?
Yes ☐ No ☐
9 Would you recommend the candidate for the position
Yes ☐ No ☐