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Professional Reference & Verification

  • Contact Information

    Please 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.
  • MM slash DD slash YYYY
  • Relationship to Candidate:

  • Basic Professional Skills

    On 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:
  • Your Assessment of the Candidate

  • Additional Information

  • Equal Opportunity Commitment

    It 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.