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Employer Reference Request Form

The document is a work/personal reference request form for an applicant named Arati Gautam, who is applying for the position of Care Assistant. It includes questions regarding the applicant's employment history, relationship with the reference, attendance, punctuality, honesty, and suitability for working with vulnerable adults. The form also addresses any disciplinary actions and the applicant's skills relevant to the position.

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Sunil Paudel
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17 views2 pages

Employer Reference Request Form

The document is a work/personal reference request form for an applicant named Arati Gautam, who is applying for the position of Care Assistant. It includes questions regarding the applicant's employment history, relationship with the reference, attendance, punctuality, honesty, and suitability for working with vulnerable adults. The form also addresses any disciplinary actions and the applicant's skills relevant to the position.

Uploaded by

Sunil Paudel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

WORK/PERSONAL REFERENCE REQUEST

Applicant’s Name Arati Gautam


Position applied for
Care Assistant
1. What is the applicant’s current/most recent position with you?

Dates of employment from to


2. In what capacity is this person known to you? (e.g., Manager, colleague, personal friend)

3. How long have you known this person


4. Please summarise the main duties and key responsibility of the current/previous post, where
applicable.

5. What are/were the applicant’s reasons for leaving (if applicable)

6. Please comment on the applicant’s attendance and punctuality.

7. Please comment on the applicant’s honesty and trustworthiness

8. Would you re-employ the applicant? Yes  No 


If no, please state reason

9. Please comment on the applicant’s relationship with colleagues

10 Do you think the applicant will be suitable to work with vulnerable adults?

/conversion/tmp/activity_task_scratch/844112334.doc/September 2006 page 1 of 2


11. Sickness Record
Please state the number of working days absence due to sickness and ill health.
Last 12 months
Previous 12 months
Please give details of individual occasions of more than 3 consecutive working days absence in
the above periods

12. Discipline
Has the applicant been subject to any disciplinary action taken against them?
Yes  No 
if yes, please provide details

13. What skills and experience do you feel that the applicant possesses that will enable him/her to
undertake the position applied for? (see enclosed job description)

Please note, in accordance with the Data Protection Act 1998 the information given may be shared
with the applicant.
Signature
Name
Position
Date
Company Company stamp

Thank you for taking the time to complete this form

For Office Use Only


Name of Person Verifying Reference
Signature of Person Verifying Reference
Job Title of Person Verifying Reference
Method of Verification Email/Telephone Call
Date

/conversion/tmp/activity_task_scratch/844112334.doc/September 2006page 2 of 2

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