Human Resources
STRICTLY CONFIDENTIAL CONTROLLED DOCUMENT
Reference Check Form
CANDIDATES DETAILS
Name as per passport
Mobile
Email
Please provide contact details of 3 referees below with at least one of them being a Direct Superior in a previous
role.
Name as per passport
Position Title
Place of work
Mobile
Email
Relationship Superior Subordinate Peer Other:
Name as per passport
Position Title
Place of work
Mobile
Email
Relationship Superior Subordinate Peer Other:
Name as per passport
Position Title
Place of work
Mobile
Email
Relationship Superior Subordinate Peer Other:
I, the undersigned, authorize UEMedical Human Resources Department to contact my referees to conduct a
reference check by email or phone, and I am aware that my referees will be asked questions related to my
performance evaluation, duration of employment, job title(s), duties performed, circumstances of separation, and
my attitude & behavior, and any other area the company deem to check.
And I do understand that any negative reference check can be a ground for the cancellation of my application/
employment.
SIGNATURE:
_____________________
Date:
Page 1 of 1
CHR/RCF;028_V2