Equal Opportunities Monitoring Form

Please indicate standard below by ticking appropriate column

Was the employee ever the subject of any disciplinary proceedings?
If Yes please give details
Do you know of any reason(s), including health, which would make this applicant unsuitable for employment by us?
Please give your opinion of the applicant's suitability for the post applied for.
Referee's Full Name
Relationship to applicant
Signed
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please attach a compliments slip or your company's headed paper to the completed form before returning.
compliments slip/ company's headed paper

Cancelof
Should be Empty:

Reference Request Form