Professional References

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APPLICANT NAME *

First

Last

JOB TITLE *

START DATE: Day / Month / Year *

END DATE: Day / Month / Year

PLEASE TICK IF STILL PRESENT

Applicant still present

REASON FOR LEAVING

PROFESSIONAL COMPETENCY

Not Applicable
Acceptable
Average
Good
Excellent

TIMEKEEPING/ATTENDANCE

Not Applicable
Acceptable
Average
Good
Excellent

ATTITUDE

Not Applicable
Acceptable
Average
Good
Excellent

RELIABILITY

Not Applicable
Acceptable
Average
Good
Excellent

HONESTY

Not Applicable
Acceptable
Average
Good
Excellent

HAS THIS APPLICANT EVER HAD ANY FORMAL DISCIPLINARY HISTORY?

WOULD YOU RE-EMPLOY?

Yes
No
Prefer not to say

WOULD YOU LIKE THIS REFERENCE TO BE MADE AVAILABLE IF THE APPLICANT REQUESTS THIS?

Yes
No

YOUR NAME *

First

Last

YOUR POSITION *

COMPANY NAME *

CONTACT NUMBER *

EMAIL ADDRESS *

DATE COMPLETED: Day / Month / Year *

I CAN CONFIRM I AM AN AUTHORISED PERSON WITHIN THE COMPANY TO PROVIDE REFERENCES AND THE INFORMATION THAT HAS BEEN SUBMITTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

I CAN CONFIRM I AM AN AUTHORISED PERSON WITHIN THE COMPANY TO PROVIDE REFERENCES AND THE INFORMATION THAT HAS BEEN SUBMITTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.