Employee Reference Check Form
Candidate Name
First Name
Last Name
Candidate NI Number (if this field is blank, this information has not yet been supplied by the candidate)
Role Applied For
Please Select
Nurse
Support Worker
Other
Date Employed From
-
Day
-
Month
Year
Date
Date Employed To
-
Day
-
Month
Year
Date
In What Capacity Do You know the Candidate
Post held by Candidate
Reason of leaving
Were there any concerns with the candidate's attendance
Yes
No
Are there any live disciplinary warnings or ongoing investigations on the candidate's file/live warnings at the time of leaving?
Yes
No
Are there any concerns relating to the candidate having access to children or vulnerable adults or working in close contact with children or vulnerable adults?
Yes
No
Please provide a brief statement about the candidate's character and suitability for the role in question
I confirm that: - the information provided above is to the best of my knowledge true, fair, accurate and not misleading - if required, this reference can be shared with the named candidate
Yes
I confirm I am authorised to supply this reference on behalf of my organisation
Yes
Your Name
First Name
Last Name
Organisation Name
Your Position
Email
example@example.com
Phone Number
If your email address does not include your organisation's name, please upload here a PDF or JPEG copy of an official company document, such as headed letter paper, business card, compliments slip or company leaflet
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