Reference Questionnaire

Reference Questionnaire for Candidate

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Reference Check

In what capacity did you employ this candidate?

If the position duties included childcare and household upkeep/management, please choose “Nanny/Childcare”

Please describe the how you employed this candidate

Who is completing this questionnaire?

Your Name (First and Last)

Who is answering this questionnaire?

Your Email

Your Phone

Your Address

Street, City, State Zipcode

We greatly appreciate you taking the necessary time to complete this reference questionnaire, providing the most accurate and honest feedback possible. All responses will remain confidential.

What kind of work did the candidate do for you? Briefly describe your experience with him/her.

How many children did the candidate care for? How old were they when he/she started?

What is the approximate square footage of the home that the candidate managed?

How long did the candidate work for you, and is he/she still employed?

Per agency requirements, can you verify that you are NOT related to the candidate?

I verify that I am not related to the candidate

I verify that I am related to the candidate

What are some words you would use to describe the candidate in this position?

If given the opportunity, would you rehire the candidate? If no, please describe why not.

Did the candidate communicate well and present himself/herself professionally? Please provide example(s).

Do you believe the candidate is passionate about working with children? Please provide example(s).

Do you feel the candidate exercised good judgement in his/her work? Please provide example(s).

Was the candidate creative in coming up with fun activities, projects and outings to do with your children? Please provide example(s).

Was the candidate flexible and able to adapt to and accommodate to your needs and schedules? Please provide example(s).

Do you feel the candidate displayed good initiative? Please describe.

Was the candidate reliable? Please provide example(s).

How would you describe the candidate’s stamina and energy level regarding the work done for you?

Is there an area you feel the candidate needs to improve on regarding the work done for you? Please describe.

Please provide an example of a situation where the candidate did something that stood out.

Would you feel comfortable recommending this candidate?

Yes

Is there anything else you would like to share with us before we consider the candidate for employment?

Do we have your permission to release your comments to potential employers?

Yes

By signing below, you verify that the information provided is true and complete to the best of your knowledge and that your identity matches that of the signature name.

Signature

Clear

Thank You!

Your feedback is important to us.

We appreciate the time and effort you're taking to complete this questionnaire on behalf of your former hire.

Questions?

If you have questions regarding this reference form, your personal data related to this questionnaire*, or any other inquiry about our screening process including how to hire for your home with Household Staffing, please contact us at any time.

*We do not use information submitted on this questiionnaire for personal contact or marketing purposes. Please see Our Terms & Conditions for more detail.

Who is completing this questionnaire?

We greatly appreciate you taking the necessary time to complete this reference questionnaire, providing the most accurate and honest feedback possible. All responses will remain confidential.

By signing below, you verify that the information provided is true and complete to the best of your knowledge and that your identity matches that of the signature name.

Thank You!

Your feedback is important to us.

Questions?

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