Employment References

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

2. Please provide dates of employment:

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:

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

If no, please explain your reasons

8. Please rate the applicant on these and add any comments as appropriate in the box below.

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: