Employer Reference

This form is used to request and collect references from past employers. Share the link with referees to have them securely provide feedback on a candidate.

Applicants Full Name*
Please enter the full name of the applicant you are providing a reference to.
Position Applied for
The job title the candidate has applied for.
- Community Care Assistant
How do you know the Applicant?*
Describe your relationship with the applicant
How long have you known the applicant for?*
Please select the length of time you have known the applicant.
- Less than 6 months
- 6 months - 1 year
- 2 - 5 years
- 5 - 10 years
- 10+
Employment Start Date*
Please provide the start date of the applicant’s employment. Approximate dates are fine if the exact date is not known.
Date Format: DD slash MM slash YYYY
Employment End Date*
Please provide the end date of the applicant’s employment. Approximate dates are fine if the exact date is not known.
Date Format: DD slash MM slash YYYY
The applicant’s job title or role?*
Enter the job title or role the applicant held at your organisation.
Reason the applicant left?*
Please provide a brief explanation of why the applicant left their role at your organisation.
Has the applicant ever been subject to disciplinary procedures?*
Please state whether the applicant was ever subject to any disciplinary procedures during their employment with your organisation.
- Yes
- No
Please briefly describe the circumstances and outcome.
Have there been any conduct issues requiring attention?*
Please state whether the applicant’s conduct has ever required formal attention or intervention during their employment.
- Yes
- No
Please briefly describe the situation and any actions taken.
Has the applicant been subject to any safeguarding enquiries or investigations?*
Please state whether the applicant’s has ever been subject to any safeguarding enquiries or investigations during their employment.
- Yes
- No
Please provide the full details of the safeguarding concern or incident.
Would you re-employ the applicant?*
Please indicate whether you would re-employ the applicant, based on their performance and conduct, regardless of your organisation’s current hiring situation.
- Yes
- No
Absence Frequency During Employment*
Please indicate how often the applicant was absent during their employment.
- None
- Rarely
- Occasionally
- Frequently
- Constantly
Punctuality*
Please rate the applicant’s performance in this area.
Honesty/integrity*
Please rate the applicant’s performance in this area.
Conduct*
Please rate the applicant’s performance in this area.
Work performance*
Please rate the applicant’s performance in this area.
Communication skills*
Please rate the applicant’s performance in this area.
Team Work*
Please rate the applicant’s performance in this area.
Caring Nature*
Please rate the applicant’s performance in this area.
Reliability*
Please rate the applicant’s performance in this area.
Criminal Convictions Note*
To protect the public, you may disclose any information you have regarding the applicant’s criminal convictions. This is permitted under the 1975 Exceptions Order, Section 4(II) of the Rehabilitation of Offenders Act 1974. Do you have any information regarding the applicant’s criminal convictions that you wish to disclose?
- Yes
- No
Please provide details here:
Form Completed By*
Please enter your full name.
Position*
Please enter the position you hold within the organisation.
Date*
Please select todays date.
Date Format: DD slash MM slash YYYY
Consent*
I confirm that the information I have provided is accurate to the best of my knowledge and that I consent to it being used for the purpose of this reference.

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