Professional Documents
Culture Documents
Please Outline
Capacity in which you know the Applicant
How long have you known the Applicant?
Job held by Applicant
Dates of Employment
Reason for leaving
Yes / No
Yes / No
Yes / No
Applicant has had ____ episodes of sickness absence in the past three years totalling ____ days
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Parental
Leave
Please provide an overview of the applicants key duties & responsibilities whilst in your employment.
Good
Satisfactory
Variable
Poor
Please comment on the candidates suitability for the post (refer attached job description) taking into
account ability, professional and personal characteristics as well as managerial ability, if appropriate,
and any other factors which you consider relevant.
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Teamwork is paramount to the successful running of our facilities. In your opinion, has the candidate
ever experienced any problems regarding relationships with others?
Please use the space below, to provide any additional information you think may be relevant.
In signing this document you agree that the information provided is a) accurate and b) unless you
indicate to the contrary, you consent under the Data Protection Legislation to this information being
disclosed to a third party such as the employee to whom this reference applies.
Please tick () as appropriate.
I agree
I disagree
Name
Company
Position
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Date
Signature
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