Employment Reference Form
Elegance Staffing Ltd
Candidate Details
Full Name of Candidate
*
First Name
Middle Name
Last Name
Position Applied For
*
Please Select
Agency Support Worker
Agency Nurse
Referee Details
Name of Referee
*
First Name
Middle Name
Last Name
Position / Job Title
*
Organization Name
*
Address
*
Relationship to Candidate
*
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Reference Information
Employment Period With Your Organisation
*
What was the candidate’s job title?
*
Attendance & Punctuality
*
Please Select
Excellent
Good
Satisfactory
Poor
N/A
Reliability
*
Please Select
Excellent
Good
Satisfactory
Poor
N/A
Professionalism
*
Please Select
Excellent
Good
Satisfactory
Poor
N/A
Attitude Toward Service Users
*
Please Select
Excellent
Good
Satisfactory
Poor
N/A
Has the candidate ever been subject to disciplinary action?
Yes
No
If yes, please provide brief details.
Would you re-employ the candidate?
Yes
No
If no, please explain.
Referee Declaration
I declare that the information provided is accurate to the best of my knowledge and reflects my honest assessment of the applicant.
Name
*
First Name
Middle Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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