Employment Referral Form

Please enter details below. Fields marked * must be completed.

Applicant Details

Name of Applicant *

In what capacity was the applicant employed by you? *

Between what dates were they employed? *
(if this is a personal reference please provide dates to represent how long you have known the applicant)

How many days did the applicant lose to sickness absence in the last year?

How would you rate the applicant in respect of...

Honesty: PoorAverageExcellent

Conduct: PoorAverageExcellent

Timekeeping: PoorAverageExcellent

Quality of Work: PoorAverageExcellent

Are there any reasons or circumstances which would make it undesirable for us to consider the application? *
YesNo

If YES please detail below

Would you re-employ this applicant? *
YesNo

If NO please detail below

You confirm that this reference is provided in strictest confidence and the information provided must only be used for the purposes for which it was requested. The information provided is to the best of the referee’s knowledge accurate at the time it is given. Neither the provider of the reference nor Way Ahead Care is accountable nor liable for any loss suffered by the person requesting the reference nor any third party should they seek to rely on the information provided *
YesNo

Please provide any further information that you feel pertinent to this application

Your Details

Your Name *

Your Position *

Company Name *

Your Telephone Number *

Date *

In the event that the applicant makes a subject access request under the Data Protection Act 1998, to view the personal data held about him/her, please confirm whether you wish us to contact you to obtain your explicit consent prior to giving him/her access to this reference. *
YesNo