SAMPLE PHONE REFERENCE SCREENING FORM for [POSITION] PRF#xxxxxx

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SAMPLE

PHONE REFERENCE SCREENING FORM for [POSITION] PRF#xxxxxx

Candidate’s Name:___________________________________________________________________________________

Reference's Name:________________________________ Title: __________________________________________

Phone: _________________________________________ E-mail Address: __________________________________

Interview conducted by:____________________________ Date: _____________________________________________

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Thank you for agreeing to talk with us today about ____________ who has applied for the [position] at Minnesota State

University, Mankato. There are a few of us here from the search committee that will be participating in this phone interview, [introduce yourselves]. Before we begin, we must first inform you that we will write some notes during the interview and put them into the candidate’s file. Under the Minnesota’s Data Practices Act, the information we receive regarding the applicant must be available to the applicant upon his/her request. Our conversation will last about

[number] minutes, as have several questions to ask.

1.

We will start with a little background information. How long have you known the candidate and what capacity?

2.

Let me describe the University and Department briefly. Minnesota State Mankato is a 16,000 student campus in the upper Midwest. The [department] offers BS and [MS] degrees, has [23] faculty, and the teaching component is greater than the research component. Do you think the candidate’s knowledge and experience are compatible with this institution? If so, please elaborate.

3.

On a scale of 1 to 10 (1 is poor, 10 is excellent), how did _________ live up to her/his responsibilities?

4.

This position can be very challenging, how would you rate _________’s ability to deal with pressure?

Please give us some examples to illustrate your views.

5.

How would you evaluate _________’s ability to teach an undergraduate/graduate courses?

Please give us some examples to illustrate your views.

4.

How would you evaluate _________’s ability to teach and coordinate a high enrollment [general education] course? This course enrolls about [800] students per semester.

Please give us some examples to illustrate your views.

5.

What experience does _________ have in providing service to the university and community?

Please give us some examples to illustrate your views.

6.

How would you evaluate _________’s ability to conduct research at a primarily undergraduate institution?

Please give us some examples to illustrate your views.

7.

How would you evaluate _________’s interpersonal interactions, communication skills, and collegiality?

Please give us some examples to illustrate your views.

8.

Describe examples of how _________ has contributed to student growth and development.

9.

What may be _________’s professional limitations in regards to this position, if any?

10.

What other information would you like to share with us about _________ and her/his qualifications for this position?

11.

If given the opportunity to re-hire or employ _________ would you do so? If not, why?

Thank the reference for his/her time. Ask reference to please maintain confidentiality.

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