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Reference Submission Form
Any information given on this form is confidential and is covered by the Data Protection Act 2018.
Who Is Reference For
*
Reference Supplied By
*
Reference Type
Previously Employed
If employed or previously employed by you. Date From
If employed or previously employed by you. Date To
Would you re-employ this person?
Yes
No
Number of days absence in the last 2 years
Time Keeping
Excellent
Good
Satisfactory
Poor
Not Known
Attendance Record
Excellent
Good
Satisfactory
Poor
Not Known
Conduct
Excellent
Good
Satisfactory
Poor
Not Known
Initiative/Reliability
Excellent
Good
Satisfactory
Poor
Not Known
Capacity to Learn
Excellent
Good
Satisfactory
Poor
Not Known
Supervision/Management of staff
Excellent
Good
Satisfactory
Poor
Not Known
Honesty & Trustworthiness
Excellent
Good
Satisfactory
Poor
Not Known
Organisational Skills
Excellent
Good
Satisfactory
Poor
Not Known
Communication Skills
Excellent
Good
Satisfactory
Poor
Not Known
Co-operation with others
Excellent
Good
Satisfactory
Poor
Not Known
Flexibility
Excellent
Good
Satisfactory
Poor
Not Known
Inter-personal skills
Excellent
Good
Satisfactory
Poor
Not Known
Reference Type
Character
Time keeping
Excellent
Good
Satisfactory
Poor
Not Known
Honesty & Trustworthiness
Excellent
Good
Satisfactory
Poor
Not Known
Reliability
Excellent
Good
Satisfactory
Poor
Not Known
Communication Skills
Excellent
Good
Satisfactory
Poor
Not Known
Inter-personal skills
Excellent
Good
Satisfactory
Poor
Not Known
Consent for storing submitted data
*
Yes, I give permission to store and process the data supplied
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