STRICTLY CONFIDENTIAL - This reference will not be shared with the candidate
REFERENCE
Candidate Name:
Address:
Reference completed by:
Organisation:
Position:
Telephone:
1. How long have you known the candidate?
Less than 1 year 1 to 3 years more than 3 years
In what capacity are you acquainted with the candidate?
Supervisory Co-worker other: _________________________________
If you are a present or previous employer then please complete all sections.
2. Can you please give the dates of his/her employment with your organisation?
From______________________________ To_________________________________
3. In what position(s) does/did the applicant work and with what client group?
__________________________________________________________________
__________________________________________________________________
4. Ability to work with the above client/client group in a professional and conscientious manner:
__________________________________________________________________
__________________________________________________________________
5. Has there been any disciplinary action, cautions or reprimands you wish to share with us?
Yes No
If yes please provide detail:
________________________________________________________________________
________________________________________________________________________
6. Have you or your colleagues ever had cause for concern about the applicant’s behaviour,
judgement or trustworthiness? (If yes, please provide details)
________________________________________________________________________
_______________________________________________________________________
1
7. How many episodes and days of sickness absence has the candidate taken in the last 12
months?
Number of episodes: ______________ Total number of days: ______________
8. To your knowledge, has this person ever abused or exposed to harm a child or young person in
any way? (If yes, what were the circumstances and what were the repercussions, if any?)
________________________________________________________________________
________________________________________________________________________
Tick the appropriate box to indicate your assessment of performance of the above candidate
Excellent (√) Good (√) Average (√) Poor (√) N/A (√)
Attitude
Ability
Initiative
Knowledge
Honesty
Timekeeping/Attendance
Reliability
Professional Competency
Report writing(if applicable)
9. If there is any further information you wish to provide in support of this candidate’s application
please record it here:
________________________________________________________________________
________________________________________________________________________
Reference completed by:
Signature:
Date:
Please affix your organisational stamp on this letter or alternatively forward your reply with
headed paper and return to:
Company Stamp:
The Ridge, McGrath Road, Castleblayney, Co.
Monaghan, A75 WY97, Ireland