Reference Request Form If you are human, leave this field blank.Reference Request For: *NameYour Name *Your PositionCompanyRelationship to candidate *Your Phone NumberYour Email Address *Employment DetailsIf the candidate was an employee or colleague of yours, please fill in this section. If not, please leave it blank.Date Employed FromDate Employed ToLeave blank if still employedCandidates Job TitleReason For LeavingLeave blank if still employedIs the Candidate suitable for re-employment by your organisation?YesNoComments / further information about the candidateGeneral ConductExcellentGoodSatisfactoryPoorTime KeepingExcellentGoodSatisfactoryPoorCommunication SkillsExcellentGoodSatisfactoryPoorRelationship With Customers / ClientsExcellentGoodSatisfactoryPoorRelationship With ColleaguesExcellentGoodSatisfactoryPoorLevel of PerformanceExcellentGoodSatisfactoryPoorAre you completely satisfied that the applicant is a suitable person to work with children and young people? *YesNoIf no, please provide detailsI declare that to the best of my knowledge the information I have given in this reference is correct and complete *I agreeSubmit
