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:
