Personal Reference Questionnaire

Personal Reference Name *


Today's Date *

Phone Number

Your e-mail address
For a copy of your answers. We will not share your personal or contact information.
The applicant's name *
How long have you known the applicant *
1) How did you meet the applicant? *
2) How often do you have contact with the applicant? *
3) How would you describe the applicant's personality? *
4) How does the applicant handle stressful situations? *
5) Have you ever known the applicant to behave in a reckless or impulsive manner?
6) Do you consider the applicant a safe driver? *
7) Are you aware of any domestic abuse during any of applicant’s past or present relationships? *
8) How does the applicant interact with people in general? *
9) How would you rate or describe the applicant’s verbal and writing skills? *
10) Are you aware of any employment problems? *
11) Have you ever observed or suspected the applicant was committing any alcohol related crimes, such as DUI or being intoxicated in a public place, or of abusing illegal drugs and/or prescription medications? *
12) Are you aware of the applicant having any negative contact with law enforcement? *
13) Has the applicant ever displayed a prejudice toward anyone because of their race, religious beliefs, ethnicity, sexual orientation, or gender? *
14) Does applicant manage their finances responsibly? *
15) Have you ever questioned applicant’s honesty or integrity (can they be trusted with confidential matters)? *
16) What areas do you think the applicant could improve? *
17) Would you recommend the applicant for this position? *
18) Is there anything I did not ask that you think is important to note? *
19) Do you know anyone else who may be able to provide information about the applicant that may not be listed in a personal history statement? *
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