Employment reference questionnaire Step 1 of 4 25% Name of Referee* First Last Referee's Employer Details* Name of Employer Street Address City County Post code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Name of applicant* First Last Job applied for* In what capacity are you giving this reference?* Line Manager Supervisor Colleague HR Department Personal Academic Other, please specify If "Other" please specify How long have you known the applicant?*Please Select...Less than 1 year1 to 3 yearsMore than 3 years Organisation/EmployerIf this is being completed as a personal or educational reference rather than an employment reference, please complete the remainder of the form to the best of your ability. Dates of Employment*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date to...*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Applicant Job Title* Applicant Key ResponsibilitiesApplicant Attendance RecordNumber of days absentTotal number of days absent due to sickness/absence in last full year. If employed for less than one year, number of days absent during the period of employment Additional commentsPlease comment generally on the attendance level Applicant RemunerationSalary on leaving Other benefits Reason for Leaving*Other details relating to applicant's employmentWould you re-employ this person in the same or similar capacity in the future?*Please Select...YesNoIf No, please state why For posts subject to an enhanced DBS check.If this post involved working with children, young people or vulnerable adults, please comment on this person’s commitment to the protection and safeguarding of children, young people or vulnerable adults:Please give details, including dates, of any formal or informal disciplinary action or allegations the applicant has been subject to in which the disciplinary sanction is current. This should include issues related to the safety and welfare of children, young people or vulnerable adults, including any in which the disciplinary sanction has expired, and the outcome.Please give details, including dates, of any allegations or concerns that have been raised about the applicant that relate to the safety and welfare of children, young people or vulnerable adults or behaviour towards children, young people or vulnerable adults, and the outcome of those concerns e.g. Whether the allegations of concerns were investigated, the conclusion reached and how the matter was resolved.Do you know of any reason why we should not employ this person?* Yes No If YES please state why How would you rate the applicant for the following?Honesty*Please Select...Above expectationsMeets expectationsBelow expectationsNot applicableReliability*Please Select...Above expectationsMeets expectationsBelow expectationsNot applicablePunctuality*Please Select...Above expectationsMeets expectationsBelow expectationsNot applicableSuitabilityHaving read the role profile are you satisfied that the person has the ability and is suitable to undertake the job?*Please Select...YesNoIf No, please state why What do you consider to be this person’s main strengths?What do you consider to be this person’s main areas for development?Is there any additional information you would like to give us that may be relevant to this application?NameThis field is for validation purposes and should be left unchanged. 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