Applicant's Name *
Position Applied For *
Date of Reference *
What is the applicant's current position with yourselves? *
Name of Referee *
Position *
Organisation *
In what capacity is this person known to you? *
How long have you known this person? *
Employed From *
Employed To (leave blank if still employed)
Please summarise the main duties and key responsibilities of the current/previous post, where applicable.
What are/were the applicant's reasons for leaving? *
Please comment on the applicant's attendance and punctuality. *
Please comment on the applicant's honesty and trustworthiness. *
Please comment on the applicant's relationship with colleagues. *
What skills and experience do you feel the applicant possesses that will enable him/her to undertake the position applied for? *
Do you think the applicant is suitable to work with vulnerable adults? * —Please choose an option—YesNo
If no, please state reason: *
Has the applicant been subject to any disciplinary action against them? * —Please choose an option—YesNo
If yes, please provide details: *
Would you re-employ the applicant? * —Please choose an option—YesNo
Are you happy for us to share this reference with future employers? * —Please choose an option—YesNo
Are you happy for us to share this reference with the candidate? * —Please choose an option—YesNo
Please be aware, confirmation that you do not wish us to share this reference with the candidate does not remove our obligations to provide this document to them upon receipt of a valid 'Subject Access Request' made under the Data Protection Act 1998.
Referee Name *
Organisation and address *
Email address *
Telephone number *
Date *
Please sign in the box below *