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Reference Assessment

As required by Oregon Administrative Rules, Northwest Care must verify and document reference checks for all potential employees. Use the space below to record job-related information provided by the reference, including observations relevant to the candidate’s qualifications, performance, reliability, and suitability for the position.

General Information

Candidate Name

Candidate Email

Reference Information

Reference Name

Relationship to Applicant

Company

Title

Reliability & Attendance

Quality of Work/Performance

Ability to Follow Policies & Instructions

Professional Conduct & Communication

Role-Specific Suitability

Overall Job-Related Summary

Attestation

Admin Name

Today's Date

Admin Signature

I certify that the information documented above reflects job-related feedback provided by the reference and does not include assumptions or commentary related to protected characteristics.
Signature