Please complete Section 1 OR Section 2 as appropriate and then sign the Declaration.





Your Name

Employee Name

Section 1: Employment Reference

Employed as:

Dates of Employment: From: To:

Reason For Leaving:
RedundancyResignationDismissal

Did this person work well as a team member and did they earn the respect of superiors and/or subordinates?

YesNo

Did this person competently and adequately perform the duties of the role?

YesNo

If not, please identify any areas of weakness:

Would you re-employ this person?

YesNo

If not, please state the reason:

Are there any current warnings on this person’s record?

YesNo

If yes, please give details:

Having considered the job description, do you think this applicant is suitable for employment with us?

YesNo

If not, please give details:

Do you consider this person to be honest, trustworthy and of the highest integrity?

YesNo

If not, please state the reasons why:

Section 2: School/College/University reference

If the person was a student at your educational establishment:

Study dates:

Course Title:

Qualifications attained:

Did this person have good timekeeping whilst at school/college/University?

YesNo

If not, please give details:

Having considered the job description, do you think this applicant is suitable for employment with us?

YesNo

If not, please give details:

Do you know of any reason why we should not employ this person?

Do you consider this person to be honest, trustworthy and of the highest integrity?

YesNo

If not, please state the reasons why:

Declaration: I confirm by hitting send that I am authorised to provide the information included on this form.

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