CATHAY LAND, INC.

CHARACTER REFERENCE FORM

I. PERSONAL INFORMATION
Name : __________________________________________________
Date Hired : __________________________________________________
Position/s Held : __________________________________________________
Entry Rate : __________________________________________________
Date Separated : __________________________________________________
Last Salary : __________________________________________________
Immediate Head : __________________________________________________

II. REASON/S FOR LEAVING: ________________________________________________

_____________________________________________________________________
III. What were his/her main duties and responsibilities?__________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

IV. PERFORMANCE RATING

The numerical rating system is based on the following:

5 – Exceptional 4 – Above Average 3- Average 2- Satisfactory 1 - Unsatisfactory

[5] [4] [3] [2] [1]

1. Was the assigned work accomplished correctly? [ ] [ ] [ ] [ ] [ ]

2. Was the work accomplished in a timely manner? [ ] [ ] [ ] [ ] [ ]
3. She/he works very well? [ ] [ ] [ ] [ ] [ ]
4. How did he/she get along with supervisors? [ ] [ ] [ ] [ ] [ ]
Co-workers? [ ] [ ] [ ] [ ] [ ]
Subordinates? [ ] [ ] [ ] [ ] [ ]
5. How was his/her attendance and punctuality? [ ] [ ] [ ] [ ] [ ]
6. Did he/she have a problem with tardiness and
absences? [ ] [ ] [ ] [ ] [ ]
7. How was his/her attitude toward work? [ ] [ ] [ ] [ ] [ ]
8. Would you characterize him/her as a hard worker? [ ] [ ] [ ] [ ] [ ]

Additional Comments:
____________________________________________________________________
____________________________________________________________________

V. PERSONALITY CHARACTERISTICS (Give your impression)

____________________________________________________________________
____________________________________________________________________

VI. HABITS (Did he/she have any problems related to any of the following)
[ ] Gambling [ ] Liquor
[ ] Drugs [ ] Extravagant Leaving
[ ] Violations of Company Rules and Regulation [ ] Undesirable Associates
[ ] Excessive borrowing of money or unserious lending
Please Explain: _________________________________________________________
 VII. Do you consider him or her:
E- Excellent VG-Very Good G-Good F-Fair U-Unsatisfactory

___ Reliable ___ Trustworthy ___ Industrious

___ Accurate ___ Fast Worker ___ Cooperative

VIII. A. Is he/she cleared all his/her accountabilities? [ ] YES [ ] NO

B. Would you rehire him/her?
[ ] YES [ ] NO Why? __________________________________________________
C. Is there anything else of relevance that I have not asked you that you think I should
knowabout this individual’s performance at work? Any comments you wish to add?
__________________________________________________________________
__________________________________________________________________

IX. OVERALL RECOMMENDATION

[ ] Favorable [ ] Unfavorable

X. RESPONDENT INFORMATION
Name : __________________________________________________
Company : __________________________________________________
Position : __________________________________________________
Date : __________________________________________________

Thank you very much!