This form is to be completed by the hiring manager before a final recommendation for hire is finalized. References should be done with prior supervisors if applicable to get the most valid information concerning the applicant’s work behaviors. You can ask questions not on this form but they must be job-related and documented on the form. Once completed, the form should be sent along with the Form 8.42 Recommendation for Hire to Human Resources.
SECTION 1 – Candidate Information
Candidate Name:	Date:
Person Contacted:	Relation to Candidate:
Dates of Employment:	From:	To:
Verify Salary on Application:	Verify Position on Application:
SECTION 2 – Reference Questions (Required)
What were the employee’s job duties and level of responsibility?
Under what type of supervision did the applicant work best?
What do you believe is the applicant’s area of strength or expertise?
To your knowledge, is there anything that might limit the applicant’s effectiveness?
What was the reason the employee left your organization?
Would you be willing to re-employ this person if you had an opening requiring his or her qualifications? Why or why not?
SECTION 3 – Competency Ratings (Required)
Competency	Excellent	Good	Average	Poor
Attendance
Initiative
Quality of Work
Safety Habits
Technical Competence
Performance Expectations Met?
Comments:

SECTION 4 – Leadership Reference Questions (Optional)
How would you describe the candidate’s management style?
How would you describe the relationship between the candidate and his or her staff?
SECTION 5 – Leadership Competency Ratings (Optional)
Competency	Excellent	Good	Average	Poor
Ability to Motivate Staff
Strategic Planning Skills
Analytical-Thinking and Problem-Solving Skills
Communications Skills
Comments:
SECTION 6 – Additional Information (Optional)
Is there any additional information you would like to add concerning the applicant?
SECTION 7 – VDOF Signatures
Comments:
Hiring Manager Name (Print)	Hiring Manager Signature	Date