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Reference Form
Reference Form
This person has given your name as a referee and I would therefore be grateful if you could complete the reference form below at your earliest convenience.
May I take this opportunity to thank you in advance for your prompt response.
Form
Please leave blank:
Name of applicant:
Position Applied for:
Job title whilst employed/engaged:
Dates of employment (to-from):
Reason(s) for leaving:
Duties and responsibilities:
Strengths:
Areas for development:
Please use this tick the most relevant box on the form below to grade the applicant on the following:
*
Punctuality:
Excellent
Very Good
Satisfactory
Poor
Attendance and health record:
Excellent
Very Good
Satisfactory
Poor
Time management:
Excellent
Very Good
Satisfactory
Poor
Relationship with service users/clients:
Excellent
Very Good
Satisfactory
Poor
Relationship with colleagues and management:
Excellent
Very Good
Satisfactory
Poor
Ability to work as part of a team:
Excellent
Very Good
Satisfactory
Poor
Ability to work alone:
Excellent
Very Good
Satisfactory
Poor
Following direction:
Excellent
Very Good
Satisfactory
Poor
Ability to make decisions:
Excellent
Very Good
Satisfactory
Poor
Written and verbal communication skills:
Excellent
Very Good
Satisfactory
Poor
Overall competency during assignments:
Excellent
Very Good
Satisfactory
Poor
Honesty and integrity:
Excellent
Very Good
Satisfactory
Poor
Do you have any further comments?
Are you aware of any disciplinaries or dismissals?
Yes
No
If yes, please give details:
Are you aware of any convictions/cautions that this applicant may have/have had (spent/unspent)?
Yes
No
If yes, please give details:
Are you aware of any incidents of insubordination or threatening behaviour?
Yes
No
If yes, please give details:
Would you re-employ?
Yes
No
Please give details / reasons:
Your Name:
Telephone:
Date:
Job title:
Address:
Company Name:
Thank you for taking the time to complete this form.
Submit
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