Reference Request Form – Service Team

Candidate Name*

Does the candidate work for you or your organisation, or have they done so in the past?*

Yes

Please state the candidates start date with the organisation*

Please state the candidates leaving date with the organisation (if applicable)*

Candidate Job Title*

Candidates reason for leaving*

If other, please specify

How long has the candidate been known to you/your organisastion?*

Less than 1 year

1-2 years

2-5 years

Over 5 years

How many sick days did the candidate have in your organisation for the total employed period?*

How many occasions of sickness did the candidate have in your organisation for the total employed period?

How many days was the candidate late in your organisation for the total employed period?*

Do you have any comments about the candidates suitability or unsuitability for this post?*

I declare that the information provided in this form is true
I agree*

I consent to this reference being disclosed to the Candidate

I consent to this reference being shared

I do not consent to this reference being shared

Your name*

Your Position/Occupation*

Your Organisation Name*