Scribd
Upload
153 views

Background Check Form

This document is a background check form for a new employee. It requests information from the employee's former supervisor or colleague to verify their employment history, interpersonal skills, work attitude, capabilities, and overall performance. The form collects details on the employee's job title, dates of employment, salary history, reasons for leaving, any offenses or awards, relationships with coworkers and clients, work efficiency, effectiveness, strengths, weaknesses, and an overall assessment. The informant is asked to provide their contact information and signature upon completion of the form.

Uploaded by

Coro Hotel
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
153 views

Background Check Form

This document is a background check form for a new employee. It requests information from the employee's former supervisor or colleague to verify their employment history, interpersonal skills, work attitude, capabilities, and overall performance. The form collects details on the employee's job title, dates of employment, salary history, reasons for leaving, any offenses or awards, relationships with coworkers and clients, work efficiency, effectiveness, strengths, weaknesses, and an overall assessment. The informant is asked to provide their contact information and signature upon completion of the form.

Uploaded by

Coro Hotel
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 1

Background Check Form

Rev: 8 May 2019

Dear Sir / Madame:

Our company is presently verifying the personal and work-related background of __________________________________who is one
of our new employees. This background check is a standard operating procedure of our company in order to properly evaluate the
qualification and character of all new hires. As former Supervisor / Colleague of the subject person, may we request you to fill up the
form below. Rest assured that your responses shall be treated with utmost confidentiality.
________________________________
Human Resource Department
Date: __________________

I. EMPLOYMENT HISTORY

Name of Company / College / Department: ______________________________________________________________


Last position held _____________________________ Date hire:________________________
Salary: monthly basic _________________________ Allowances ______________________
Date of resignation ___________________________ Reason for leaving ________________

1. Based on your company records and 201 file, has the subject __ No
employee been charged / found guilty of any offense / violation? __ Yes, specify: __________________________
2. Has the subject been given an award, citation, commendation, __ No
or promotion based on actual performance on the job? __ Yes, specify: ___________________________
II. INTERPERSONAL RELATIONS Very
Poor Poor Fair Good Excellent
1. Relationship of the subject w/ immediate superior 1 2 3 4 5
2. Relation of the subject w/ colleagues 1 2 3 4 5
1. Relation of the subject with subordinates 1 2 3 4 5
4. Relation of the subject w/ clients 1 2 3 4 5
III. WORK ATTITUDE AND CAPABILITIES Very
Poor Poor Fair Good Excellent
1. How would you rate the work efficiency level of the subject? 1 2 3 4 5
2. How would you rate the work effectiveness of the subject? 1 2 3 4 5
3. Please rate his/her potential to handle the position :
_______________________________________________ 1 2 3 4 5
IV GENERAL INFORMATION
1. What type of work does the subject like to do? _________________________________________
2. What are the talents and hobbies you know about the subject? _________________________________________
3. Any information on the strengths / weaknesses of the subject? _________________________________________
4. Please give an over-all assessment of the subject as a whole
in terms of his/her performance on the job? _________________________________________
5. Other comments / remarks? _____________________________________________________________________
V INFORMANT
NAME & SIGNATURE : ____________________________________________
RELATION WITH SUBJECT : ____________________________________________
OFFICIAL DESIGNATION : ____________________________________________
TELEPHONE NUMBER : ____________________________________________
E-MAIL : ____________________________________________
SIGNATURE : ____________________________________________

HRD – F004 Background Check Form

You might also like