Employee Reference Request (Schools)

Employee Reference Request
Reference Request For:*

First NameLast Name
Date employed from

DayMonthYear
Date
Date employed to

DayMonthYear
Date
Was the position:*

PermanentContractSupply
Was the employment:*

Full TimePart Time
If the employment was part time, please confirm the hours worked per week
Name of establishment employed at*
Establishment type:*

SchoolNurseryCollegeUniversityOther
Position held by applicant*
Please confirm your relationship with the applicant:*

Line ManagerSchoolHeadteacherSupervisorOther
Please confirm age groups taught:*

0-55-88-1212-1616-18Higher EducationOther
Subject areas taught/supported*
Would you re-employ the applicant?*

YesNo
If you selected No, please elaborate below
Reason/s for leaving your employment?*
Was the applicant undergoing any stage of disciplinary proceedings or subject to any investigation when he/she left your employment?*

YesNo
If you selected Yes, please provide details below
Does the applicant have any history of disciplinary action that relates to the safety of children?*

YesNo
If you selected Yes, please provide details below
Do you know of any reason why the applicant should not be engaged to work with children?*

YesNo
If you selected Yes, please provide details below:

Please grade the applicant on the following by selecting the boxes that most closely correspond to their competence level:

Rows	Excellent	Good	Average	Poor	Not Applicable
Pupil/class control & discipline
Professionalism & conduct
Teaching ability
Preparation & planning
Relationship with students
Suitability for a supply position

Pupil/class control & discipline*

ExcellentGoodAveragePoorNot Applicable
Professionalism & conduct*

ExcellentGoodAveragePoorNot Applicable
Teaching ability*

ExcellentGoodAveragePoorNot Applicable
Preparation & planning*

ExcellentGoodAveragePoorNot Applicable
Relationship with students*

ExcellentGoodAveragePoorNot Applicable
Suitability for a supply position*

ExcellentGoodAveragePoorNot Applicable
Comments/further information
I declare that to the best of my knowledge the information I have given in this reference is correct and complete*

I Agree
Your Name *

First NameLast Name
Your Position*
Employer Name
E-mail*
example@example.com
Phone Number
Signature*

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