Character Reference Form – Job Application
Confidential – For Employment Purposes
Applicant Information
Applicant Full Name: _________________________________
Position Applied For: _________________________________
Company Name: _______________________________________
Referee Information
Referee Full Name: ___________________________________
Relationship to Applicant: ____________________________
Length of Time Known: ________________________________
Job Title / Organization: _____________________________
Phone: ___________________ Email: _______________
Character Evaluation
Please rate the applicant using the following scale: 1 = Poor | 2 = Fair | 3
= Good | 4 = Very Good | 5 = Excellent
Attribute 1 2 3 4 5
Integrity & Ethics ☐ ☐ ☐ ☐ ☐
Reliability & Work Ethic ☐ ☐ ☐ ☐ ☐
Communication Skills ☐ ☐ ☐ ☐ ☐
Teamwork & ☐ ☐ ☐ ☐ ☐
Professionalism
Ability to Handle ☐ ☐ ☐ ☐ ☐
Responsibility
Incorporated in England. Registered No. 15681341 Care Assist 247 Limited Portland House 113-116 Bute Street,
Cardiff
CF10 5EQ
Phone: 07592544100
Brief Written Reference
Please comment on the applicant’s suitability for employment and
provide an example of their character or work ethic (if applicable):
Overall Recommendation
Recommendation: ☐ Highly Recommend ☐ Recommend ☐
Recommend with Reservations ☐ Do Not Recommend
Declaration
I confirm that the information provided is accurate to the best of my
knowledge.
Referee Signature: __________________________ Date: ________________
Printed Name: _______________________________
Thank you for providing this employment reference.
Incorporated in England. Registered No. 15681341 Care Assist 247 Limited Portland House 113-116 Bute Street,
Cardiff
CF10 5EQ
Phone: 07592544100