Reference Request

Applicant Name

First

Last

Reference Name

First

Last

Reference Contact Number

Reference Email

How long have you known the applicant?

Where did you work with the applicant?

How long did you work together with the applicant?

Start Date

End Date

Reason for leaving - Please check box

Voluntary
End of Contract
Dismissed
Redundancy

Would you re-employ this person?

Please select the capacity in which you worked with the applicant.

Manager
Coworker
Other

Do you consider the applicant to be honest?

Yes
No
Not sure

Please rate the applicant on the following characteristics.

	Excellent	Very Good	Good	Okay	Poor	Not Sure
Communication	ExcellentCommunication Excellent	Very GoodCommunication Very Good	GoodCommunication Good	OkayCommunication Okay	PoorCommunication Poor	Not SureCommunication Not Sure
Organisation	ExcellentOrganisation Excellent	Very GoodOrganisation Very Good	GoodOrganisation Good	OkayOrganisation Okay	PoorOrganisation Poor	Not SureOrganisation Not Sure
Time management	ExcellentTime management Excellent	Very GoodTime management Very Good	GoodTime management Good	OkayTime management Okay	PoorTime management Poor	Not SureTime management Not Sure
Dependability	ExcellentDependability Excellent	Very GoodDependability Very Good	GoodDependability Good	OkayDependability Okay	PoorDependability Poor	Not SureDependability Not Sure
Attitude	ExcellentAttitude Excellent	Very GoodAttitude Very Good	GoodAttitude Good	OkayAttitude Okay	PoorAttitude Poor	Not SureAttitude Not Sure
Helpfulness	ExcellentHelpfulness Excellent	Very GoodHelpfulness Very Good	GoodHelpfulness Good	OkayHelpfulness Okay	PoorHelpfulness Poor	Not SureHelpfulness Not Sure
Maturity	ExcellentMaturity Excellent	Very GoodMaturity Very Good	GoodMaturity Good	OkayMaturity Okay	PoorMaturity Poor	Not SureMaturity Not Sure
Ability to work with others	ExcellentAbility to work with others Excellent	Very GoodAbility to work with others Very Good	GoodAbility to work with others Good	OkayAbility to work with others Okay	PoorAbility to work with others Poor	Not SureAbility to work with others Not Sure
Hardworking	ExcellentHardworking Excellent	Very GoodHardworking Very Good	GoodHardworking Good	OkayHardworking Okay	PoorHardworking Poor	Not SureHardworking Not Sure
Punctual	ExcellentPunctual Excellent	Very GoodPunctual Very Good	GoodPunctual Good	OkayPunctual Okay	PoorPunctual Poor	Not SurePunctual Not Sure
Creative	ExcellentCreative Excellent	Very GoodCreative Very Good	GoodCreative Good	OkayCreative Okay	PoorCreative Poor	Not SureCreative Not Sure

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