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Employer Reference Request

Your Details:

Please enter your details below as the referee:

Applicant's Details:

Please enter the details of the applicant:

Please enter the position that the applicant has applied for with us:

Employment History

Please provide the following information for the above named applicant:

Suitability of the applicant for the post:

This role involves working with vulnerable adults. Please can you comment on the candidate's suitability from a safeguarding perspective.:

On the basis of your experience of the applicant can you let us know how you would assess them on the following personal characteristics:

Attitude To Work:
Commitment to equal opportunities:
Application to the job:
Relationship with others:

Did the applicant have any disciplinary, performance or attendance warnings during his/her last 12 months’ employment with you, or have any current live warnings on their file?
If YES, please provide details:

Disciplinary or warnings?

From your knowledge of the applicant, would you re-employ them?

Would you re-employ?

Can you tell us the level of sickness absence taken by them over the last 12 months? If they have been employed with you less than that time, please give the number of months that the sickness absence applies to. Please answer A and B below.

In terms of the nature of the absence (if any) can you tell us which one description best relates their sickness absence being primarily due to: (tick one)


In accordance with the Data Protection Act 1998, in the event of a subject request for access to/for copies of personnel data held by us, we will provide them with copies of references provided.

After you click 'SUBMIT' please wait for confirmation pop up of sending before moving away from this form.

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