Employee Reference

Date Applicant Started(Required)
Date Applicant Left(Required)
Please enter a number from 0 to 730.
Are you aware of any criminal convictions the applicant has?(Required)
Are you aware of any physical or mental illness that may affect their performance?(Required)

Please Give Your Opinion As To The Following

Ability to perform his / her duties:(Required)
Relationship with other Staff members:(Required)
Attendance/Time keeping/Reliability:(Required)
Ability to work unsupervised:(Required)
Characters in general i.e. Honesty/Attitude:(Required)
Would you re-employ this person?(Required)
Please indicate whether we can disclose this information to the candidate upon request:(Required)
Was the applicant sent to Care/Residential/Nursing homes through your company? (applicable only for agencies)

Reference completed by: