A Caring Connection Employee Reference Request
Reference name
*
Reference position
*
Reference email
example@example.com
REFERENCE REQUEST FOR
*
Company Name & Address where worked with candidate
Relationship with candidate
*
1. Employment Details
If applicable
Date Employed From
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Date Employed To
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Candidates Job Title
Reason For Leaving
Re-employ?
Yes
No
Not applicable
Comments/further information
2. Please Comment On The Following
General Conduct
*
Excellent
Good
Satisfactory
Poor
Timekeeping
*
Excellent
Good
Satisfactory
Poor
Communication Skills
*
Excellent
Good
Satisfactory
Poor
Relationship with colleagues
*
Excellent
Good
Satisfactory
Poor
Relationship with patients
Excellent
Good
Satisfactory
Poor
Has the candidates honesty and integrity ever been brought into question that you are aware of? (Please comment)
*
Level of performance
*
Excellent
Good
Satisfactory
Poor
Additional comments. If you have ticked satisfactory or poor for any of the above please provide us with further explanatory information
I declare that to the best of my knowledge the information I have given in this reference is correct and complete
*
I Agree
Phone Number
-
Area Code
Phone Number
Please verify that you are human
*
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