Employment reference questionnaire

Name of Referee*
First Last
Referee's Employer Details*
Name of Employer Street Address City County Post code Country
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?*

Organisation/Employer
If 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*
Date to...*
Applicant Job Title*
Applicant Key Responsibilities
Applicant Attendance Record
Number of days absent
Total 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 comments
Please comment generally on the attendance level
Applicant Remuneration
Salary on leaving
Other benefits
Reason for Leaving*
Other details relating to applicant's employment
Would you re-employ this person in the same or similar capacity in the future?*
If 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*
Reliability*
Punctuality*
Suitability
Having read the role profile are you satisfied that the person has the ability and is suitable to undertake the job?*
If 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?
Comments
This field is for validation purposes and should be left unchanged.

Organisation/Employer