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Reference request

Step 1 of 3 - About the applicant

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About the applicant

Use this form to send a reference request. Simply fill in the details and an email will be sent to the referee.

Applicant name*

First Last

Applicant job title*

Date of birth*

DD slash MM slash YYYY

Reference questions

Job title*

Date from*

Day

Month

Year

Date to*

Day

Month

Year

Specific dates of employment (Please use exact dates)

Nature of work, specific duties, responsibilities*

Reason for leaving employment?*

If dismissed, please supply details:

Was the applicant honest and trustworthy at all times?*

Yes

As you've answered 'no' to the previous question, please can you supply details?*

During employment was the applicant the subject of a disciplinary procedure?*

Yes

As you've answered 'yes' to the previous question, please provide more details and the outcome.*

Would you re-employ the applicant?*

Yes

As you have indicated 'no' can you please state the reason(s) why?*

If you have any other information you feel would be relevant to an employer about this applicant, please share it here.

Please tick the option which accurately applies to the applicant

General conduct*

Excellent

Good

Satisfactory

Below average

Poor

Work performance*

Excellent

Good

Satisfactory

Below average

Poor

Attitude at work*

Excellent

Good

Satisfactory

Below average

Poor

Initiative*

Excellent

Good

Satisfactory

Below average

Poor

Time keeping*

Excellent

Good

Satisfactory

Below average

Poor

Relationship with colleagues*

Excellent

Good

Satisfactory

Below average

Poor

Relationship with customers*

Excellent

Good

Satisfactory

Below average

Poor

The reference provider

These are the details of the person that will provide the reference

Name*

First Last

Email*

Signature*

Date*

Phone

This field is for validation purposes and should be left unchanged.

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Reference request

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