Reference Request Form

    Reference Applicant Name

    In what capacity do you know the applicant?
    EmployerPersonalEducational

    Dates of Employment / How long have you known the applicant?

    If you selected personal/educational above you can skip the Employment Information section below and move on to the Applicant Attributes section.


    Employment Information

    Job Title (whilst in your employment)

    Salary upon Leaving

    What did the job involve?

    Reason for Leaving

    If a suitable opening existed, would you re-employ?
    YesNo


    Applicant Attributes

    How would you rate the following attributes?

    Commitment:
    ExcellentGoodAveragePoor

    Timekeeping:
    ExcellentGoodAveragePoor

    Honesty:
    ExcellentGoodAveragePoor

    Reliability:
    ExcellentGoodAveragePoor

    Initiative:
    ExcellentGoodAveragePoor

    Quality of Work:
    ExcellentGoodAveragePoor

    How would you assess absenteeism due to sickness?
    Very LowLowAverageExcessive

    May we have your permission to discuss, where appropriate, the information contained in this reference with a potential employer?
    YesNo

    Do you have any other comments that may help us find suitable employment for this applicant?


    Referee Details

    Form completed by:

    Company/Institution:

    Position:

    Date:

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