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Reference request
Reference Request
Name of the person that you are completing a reference for
*
First
Last
The position they held whilst in your employ
*
The date they were employed from
*
MM slash DD slash YYYY
The date they were employed until
*
MM slash DD slash YYYY
Or select today’s date if still currently employed
Your company's referencing policy
*
It is our company policy to only confirm dates of employment
I am happy to continue and provide further information
Character
On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's honesty?
1
2
3
4
5
On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's punctuality?
1
2
3
4
5
On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's reliability?
1
2
3
4
5
On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's attitude?
1
2
3
4
5
On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's flexibility?
1
2
3
4
5
Attendance and Sickness
If known, then please enter the number of days sickness in the last 2 years
If known, then please enter the number of episodes of sickness in the last 2 years
Warnings and Investigations
Are there any current warnings on the applicant's record
Yes
No
If yes, then please give details
Is the applicant currently under investigation for any matter?
Yes
No
If yes, then please give details
General
How do you feel the applicant interacted with patients / clients?
Please comment on any particular strengths or weaknesses of the applicant?
Please state the reason (if known) for the applicant leaving your employment
Would you re-employ the applicant?
Yes
No
It’s company policy to not re-employ
Confirmation
I am confirming that the information I am providing is accurate to the best of my knowledge:
*
I confirm
Date reference provided
*
MM slash DD slash YYYY
Name of referee
*
First
Last
Position of referee
*
Company
*
Email address (if required for verification)
*
