Reference request form

Applicant's name

First Name

Last Name

Referee's name

First Name

Last Name

Applicant job title

Name of company/organisation.

Phone number

Capacity in which the candidate is known to you:

How long have you known the candidate?

Dates of employment (if applicable):

Hourly rate or salary:

Reason for leaving:

Was the candidate subject to any formal form of performance management/disciplinary action within the last 12 months?

Please provide further details below.

Would you employ the candidate again?

Please provide further details below.

Please rate your experience of the candidate’s performance in the following areas:

Professional conduct

Reliability and integrity

Dignity and respect

Compassion, empathy and the ability to empower others

Motivation, commitment and attitude

Learning and development interest

Team working ability

Quality and safety

Education and qualifications

Skills

Overall contribution as a member of staff

Did you find the applicant to be honest and trustworthy?

Did you find the candidate to be reliable in carrying out her/his duties?

Was the candidate’s time-keeping acceptable?

Do you think that the candidate would be a suitable person to undertake this post?

Please provide additional comments below:

Are you aware of any safeguarding concerns, allegations (whether formal or informal), or other information relating to the candidate's conduct, behaviour, or suitability to work with children, young people, or adults at risk?

Please detail any safeguarding concerns, allegations (whether formal or informal), or other information relating to the candidate's conduct, behaviour, or suitability to work with children, young people, or adults at risk:

Your signature ⤵

First Name

Last Name

Your job title

Date signed

Thank you for providing this information.