Professional Reference & Verification Contact InformationPlease provide complete answers and details as necessary. Thank you for your assistance. Should you have questions regarding this form or any of the question please call: 770-977-0795 x 108.Date* MM slash DD slash YYYY Candidate Name* First Last Person Completing Form* First Last Phone*Email Relationship to Candidate:How long have you known the candidate?*Where did you work with the candidate?*What was your title at that time?*What was the candidate's title at the time?* What is your current title?*What was your professional relationship?* Peer Managed Candidate Reported to Candidate Other: Basic Professional SkillsOn a scale of 1-5, with 5 being the highest, rate the candidate in the following areas. Any score 3 or less, provide an explanation in the note section below:Verbal Communication*Choose a rating12345N/AWritten Communication*Choose a rating12345N/AIndustry Knowledge*Choose a rating12345N/AProfessionalism*Choose a rating12345N/AWork Ethic/Work Habits*Choose a rating12345N/APunctuality*Choose a rating12345N/ADependability*Choose a rating12345N/ANote:Your Assessment of the CandidateWhat are the candidate's strengths?*What are the candidate's weaknesses or areas in which (s)he could improve?*How would you describe the candidate's personality?*What was the candidate's greatest accomplishment while at the organization?*How did the candidate get along with Co-Workers, Supervisors or Senior Management?*How would you describe the candidate’s management or leadership skills? If the candidate is not currently in a management role, does (s)he exhibit leadership skills? If so, please explain (daily tasks, committees, etc.).*Candidate’s reason for leaving the organization, if known?*Would you hire or rehire the candidate if given an opportunity? If not why?*Additional InformationIs there anything else you would like to share about the candidate that will help us or our client evaluate them?*Can our client contact you directly if there are any remaining questions?* Yes No Equal Opportunity CommitmentIt is the policy and practice of Galileo Search, LLC to provide equal employment opportunity for all employees and candidates for employment without regard to age, sex, race, color, religion, national origin, disability, or sexual orientation, and to observe all applicable requirements of local, state and federal law.