|Name of applicant:|
|1. In what capacity do you know the applicant? (e.g. as a former employee, friend, etc)|
|2. How many years have you known the Applicant?|
|3. In your opinion is the applicant an honest and reliable person?|
|4. Please write here any other comments you would like to make regarding the applicant, and which would be of interest to a prospective employer.
(Please continue on a separate sheet if necessary)
|(Questions 5-8 to be answered by former employers only)|
|5. (a) Please state the dates during which the applicant was employed by you or your organisation and in what capacity they were employed.|
|(b) During the period the applicant was employed by you, would you say their timekeeping was:
(ii) average, or
(iii) below average?
|(c) (i) how many days sickness has the applicant taken in the last year?
(ii) how many periods of sickness has this consisted of?
|(d) Did the applicant take parental leave and if so:
(i) for how long; and
(ii) what was the name of the child?
|6. Would you re-employ the applicant? If not, why not?|
|7. What was the applicant’s reason for leaving your employment?|
|8. What was the applicant’s salary at the time of leaving?|
|Is this reference given in confidence?||YES/NO (delete as appropriate)|
(if applicable company stamp)
|Name of person signing:|