Employment References

1. Please provide details of your organisation and the person you are referencing:

Your Organisation (required)Your Name (required) Your Job Title (required) Candidate's Name (required)Candidate's Job Title (required)

2. Please provide dates of employment:
From(required)To (required)

3. Why did /does the applicant leave/wish to leave your organisation?

4. Are you related to the applicant in any way? Yes / No. If yes, please give details

5. In the applicants last two years of employment with you:
How many days of sickness absence did they take? (required)
How many periods of sickness absence did they have? (required)

6. Does the applicant have any disciplinary actions on their file or are they subject to an investigation or disciplinary hearing? If yes, please give details.

7. Would you re-employ the applicant? If no, please explain
YesNo
If no, please explain your reasons

8. Please rate the applicant on these and add any comments as appropriate in the box below.
Learns from situations and past experience
PoorAdequateGoodExcellentUnable to comment

Plans, structures and prioritises own work
PoorAdequateGoodExcellentUnable to comment

Communicates effectively
PoorAdequateGoodExcellentUnable to comment

Teamwork
PoorAdequateGoodExcellentUnable to comment

Provides assistance when required
PoorAdequateGoodExcellentUnable to comment

Problem Solving
PoorAdequateGoodExcellentUnable to comment

Involves others in decision making affecting them
PoorAdequateGoodExcellentUnable to comment

Developing Own Capability
PoorAdequateGoodExcellentUnable to comment

Meeting Clients Needs
PoorAdequateGoodExcellentUnable to comment

Seeks ideas for improvement
PoorAdequateGoodExcellentUnable to comment

Refers problems upwards when appropriate
PoorAdequateGoodExcellentUnable to comment

Managing Own Work
PoorAdequateGoodExcellentUnable to comment

Works hard to achieve objectives and goals
PoorAdequateGoodExcellentUnable to comment

Resilient under pressure
PoorAdequateGoodExcellentUnable to comment

Flexible and open to new ways of working
PoorAdequateGoodExcellentUnable to comment

9. Do you have any other relevant comments you wish to make regarding the applicant?

* 10. Are you happy for us to show the candidate a copy of this reference:
Yes
No