Reference check consent form template

Form Control and Routing Information

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Completion Instructions

1. Candidate Instructions: Complete Section 1.2, Section 2.1, and Section 4.2. Provide a minimum of 2 professional supervisory references who have direct knowledge of your work performance. Submit the completed form to [OWNER_OR_MANAGER] within [N_BUSINESS_DAYS] business days of receipt.
2. Hiring Manager Instructions: Complete Section 1.1, verify referee details in Section 2.1, conduct structured reference calls using the criteria in Section 2.2, complete the assessment rubric in Section 2.3, and record the hiring decision in Section 5.
3. Accommodation Notice: If you require accommodation at any stage of the reference verification process, notify [OWNER_OR_MANAGER]. Alternative formats and communication methods are provided upon request.
4. Incomplete Submissions: Incomplete forms or missing candidate signatures will pause the recruitment process for the candidate until all required fields are provided.

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1. Requester & Subject Details

1.1 Position and Hiring Context

Position and Requester Identity Fields

1.2 Candidate Identification

Candidate Identity and Contact Fields

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2. Request or Assessment Information

2.1 Professional Referee Nominations

Referee Contact and Relationship Roster

2.2 Inquiry Boundaries and Human Rights Compliance

The hiring manager must align reference questions strictly with bona fide occupational requirements and structured competencies.

Prohibited Inquiry Areas: Under Canadian human rights legislation, the person conducting the reference check must not ask questions relating to:

1. Age, date of birth, or projected retirement timing.
2. Race, ancestry, place of origin, ethnic origin, or citizenship beyond confirmation of legal authorization to work in Canada.
3. Marital status, family status, pregnancy, parental leaves, or childcare arrangements.
4. Physical or mental disability, medical history, workers' compensation claims, or sick leave usage.
5. Creed, religion, political beliefs, or sexual orientation.
6. Record of offences, unless directly related to a bona fide occupational qualification.

2.3 Structured Reference Assessment Rubric

Standardized Reference Check Evaluation Rubric

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3. Supporting Documentation

Supporting Verification Documentation Checklist

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4. Review & Decision

4.1 Privacy and Collection Notice

[ORGANIZATION_NAME] collects personal information contained in this form and gathered during reference checks solely to assess candidate suitability, qualifications, and employment history for the position of [JOB_TITLE]. Information collected will be reviewed exclusively by [OWNER_OR_MANAGER] and designated hiring evaluators.

Personal information collected will be retained in secure files at [FILE_LOCATION] for [RETENTION_PERIOD] following the conclusion of the recruitment process, after which it will be securely destroyed. Candidate information will not be disclosed to any third party without express written consent, except where required by law.

4.2 Candidate Declaration and Consent

Attestation Statement: I hereby certify that the information provided in this form is true, accurate, and complete. I authorize [ORGANIZATION_NAME] and its designated representatives to contact the individuals listed in Section 2.1 to verify my previous employment, job performance, technical competencies, and rehire eligibility. I authorize the referees listed to disclose relevant, job-related information concerning my performance to [ORGANIZATION_NAME]. I understand that any intentional misrepresentation or omission may result in disqualification from the hiring process or termination of employment if discovered after hire.

Candidate Consent Execution

4.3 Reference Evaluation Scoring and Decision Thresholds

Weighted Score Calculation Formula: $$\text{Weighted Score} = \sum (\text{Criterion Score} \times \text{Weight \%})$$

Score-to-Decision Mapping and Action Thresholds

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5. Approval & Recordkeeping

Internal Hiring Review, Decision, and Recordkeeping

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What to fill in

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