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*

The date they were employed until*

Or select today’s date if still currently employed

Your company's referencing policy*

Character

On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's honesty?

On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's punctuality?

On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's reliability?

On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's attitude?

On a scale of 1-5, with 5 being excellent and 1 being poor how would you rate the applicant's flexibility?

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

Are there any current warnings on the applicant's record

If yes, then please give details

Is the applicant currently under investigation for any matter?

If yes, then please give details

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?

I am confirming that the information I am providing is accurate to the best of my knowledge:*

Date reference provided*

Name of referee*

First

Last

Position of referee*

Company*

Email address (if required for verification)*