DA Form 3439: Employment Reference Inquiry

Write the applicant's name (Last, First, Middle Initial) in Box 1.

In Box 2, how long have you known applicant and in what capacity(ies)?, check the applicable block and enter below the capacity and approximate time known: supervisor, fellow employee, acquaintance, or other (specify).

In Box 3, write the reason for leaving if no longer employed with you.

In Box 4, would you reemploy applicant?, check YES or NO (If no, indicate reasons under "Remarks.").

In the personal appraisal, based on your experience with applicant, indicate by check mark in the appropriate column your evaluation of the following factors: 5. a. Dependability - accepts assigned responsibility and effectively accomplishes duties; has little or no time or attendance issues. b. Cooperation - a team worker, maintains good working relationships. c. Initiative and creativeness - ability to think along original lines and to work without detailed instructions or supervision. d. Sound judgement/ability to adapt under pressure - poise and judgment in meeting adverse or emergency situations. e. Adaptability - ability to adjust to changes in working or living environments. f. Consideration for others - courteous in daily contacts including attitude toward different races, religions, and nationalities; the columns are outstanding, better than average, adequate, unsatisfactory, insufficient opportunity to observe.

g. COMPLETE ONLY IF CHECKED: job knowledge - has knowledge of techniques and procedures applicable to the job for which being considered; managerial skills - ability to plan and organize work.

Supervision - ability to supervise other employees; child care services - has the ability and patience needed to work with and relate to children and youth in a positive manner.

Check yes or no for Box 6 (Do you have any reason to question this person's loyalty to the United States?) and Box 7 (Do you have any knowledge of any behavior, activities, or associations which tend to show that this person is not reliable, honest, trustworthy, and of good conduct and character?). (If any answer is "YES" to the following questions, give details under "Remarks.")

Check yes or no for Box 8 (Have you ever observed or do you have knowledge of any behavior that would make you reluctant to hire or recommend this person for a position working with or caring for children/youth?), and write details under "Remarks" and reasons under "Remarks" in 9. Remarks.

Write the reference's name (Last, First, Middle Initial) in 10 and the date (YYYYMMDD) in 12; the reference signs on 11. Reference's signature (or phone number if completed telephonically).

If completed telephonically: enter the POC's name and position in Box 13, sign on 14. POC's signature, and enter the date (YYYYMMDD) in Box 15.

The second page is to fill in: To; Dear; ... is being considered by this office; for a position as; In the application for employment, the candidate indicates: your name as a reference, or association with your organization from.