Clone of Employee Reference Request (Schools)

Healthcare Employee Reference Request
Reference Request For:

First NameLast Name
Date employed from

DayMonthYear
Date
Date employed to

DayMonthYear
Date
Was the position:
Was the employment:
If the employment was part time, please confirm the hours worked per week
Name of establishment employed at
Establishment type:

Other
Position held by applicant
Please confirm professional relationship with applicant:
(for example: Manager, Clinical Supervisor, Employer etc.)
What were the applicants professional responsibilities:
Would you re-employ the applicant?
If you selected No, please elaborate below
Reason/s for leaving your employment/workplace?
Was the applicant undergoing any stage of disciplinary proceedings or subject to any investigation when they left your employment?
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:

Pupil/class control & discipline
Professionalism & conduct
Teaching ability
Preparation & planning
Relationship with students
Suitability for a supply position
Comments/further information
I declare that to the best of my knowledge the information I have given in this reference is correct and complete
Your Name

First NameLast Name
Your Position
Employer Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Signature
Should be Empty:

Healthcare Employee Reference Request