Employee Reference Request Form

Employee Reference Request
REFERENCE REQUEST FOR
Your Name & Position
Company Name & Address where worked with candidate
Relationship with candidate
1. Employment Details
Date Employed From

DayMonthYear
Date Employed To

DayMonthYear
Candidates Job Title
Reason For Leaving
Re-employ?
Comments/further information
2. Please Comment On The Following
General Conduct
Timekeeping
Communication Skills
Relationship with colleagues/nursing staff
Relationship with patients/service users
Level of performance
Are you aware of any suspicious proceedings, Policy investigations or disciplinary action?
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
E-mail
Phone Number

Area CodePhone Number
Should be Empty:

Employee Reference Request