Employee Reference Applicants Full Name(Required)Name of Organisation (Required)(Required)The Position the Applicant Held(Required)How long and in what capacity have you known the applicant?Date Applicant Started(Required) Day Month Year Date Applicant Left(Required) Day Month Year What was their reason for leaving?(Required)How many days sickness did they have in the last 2 years?(Required)Please enter a number from 0 to 730.Are you aware of any criminal convictions the applicant has?(Required) Yes No Are you aware of any physical or mental illness that may affect their performance?(Required) Yes No Please Give Your Opinion As To The FollowingAbility to perform his / her duties:(Required) Poor Average Very Good Excellent Other Relationship with other Staff members:(Required) Poor Average Very Good Excellent Other Attendance/Time keeping/Reliability:(Required) Poor Average Very Good Excellent Other Ability to work unsupervised:(Required) Poor Average Very Good Excellent Other Characters in general i.e. Honesty/Attitude:(Required) Poor Average Very Good Excellent Other Would you re-employ this person?(Required) Yes No If no please give details below:Any other comments you wish to make?Please indicate whether we can disclose this information to the candidate upon request:(Required) Yes No Was the applicant sent to Care/Residential/Nursing homes through your company? (applicable only for agencies) Yes No Reference completed by:First Name(Required)Surname(Required)Position(Required)
