Employee Reference Request

REFERENCE REQUEST FOR*
Your Name & Position*
Company Name & Address where worked with candidate*
Relationship with candidate*
1. Employment Details
Date Employed From*

DayMonthYear
Date Employed To*

DayMonthYear
Candidates Job Title*
Reason For Leaving*
Re-employ?*

YesNo
Comments/further information
2. Please Comment On The Following
General Conduct*

ExcellentGoodSatisfactoryPoor
Timekeeping*

ExcellentGoodSatisfactoryPoor
Communication Skills*

ExcellentGoodSatisfactoryPoor
Relationship with colleagues*

ExcellentGoodSatisfactoryPoor
Relationship with Cutomers*

ExcellentGoodSatisfactoryPoor
Has the candidates honesty and integrity ever been brought into question that you are aware of? (Please comment)*
Level of performance*

ExcellentGoodSatisfactoryPoor
Are you aware of any suspicious proceedings, Policy investigations or disciplinary action?*
Additional comments. If you have ticked satisfactory or poor for any of the above please provide us with further explanatory information
I declare that to the best of my knowledge the information I have given in this reference is correct and complete*

I Agree
E-mail
Phone Number

Area CodePhone Number
Should be Empty:

1. Employment Details