National Rural Support Programme Reference Check General Information: Name of Candidate:- Contact :- Position Applied for: E-Mail:- Reference Information: Name: Contact:- Title/Position: Email: Organization: Location: Nature of Relationship with the Candidate ______________________________________________________ Background & Experience: 1. What position(s) did the candidate hold, during the period in question? ___________________________________________________________ 2. When did the applicant work for your organization/company? From __________ to __________ 3. What were the candidate’s assigned roles, responsibilities and activities? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2 Reasons for leaving your organization/company. __________________________________________________________________ __________________________________________________________________ Personal Suitability: 1. Please rate the candidate in the following areas: Quality of Work Excellent Good Satisfactory Poor Discipline/Attendance Excellent Good Satisfactory Poor Team Interaction Excellent Good Satisfactory Poor Integrity/Honesty Excellent Good Satisfactory Poor 2. YES Has he/she been subject to any disciplinary action due to sexual harassment or financial irregularity: NO If “YES” Please describe:- __________________________________________________________________ __________________________________________________________________ Please tick this box if you do not wish to pass this information to the individual concerned Thank you on behalf of NRSP and the candidate for the time you have taken in completing this. Signature & Date__________________________