Reference RequestPlease complete this form in reference to the applicant named in the original email you received. 1. Name of Referee * First Name Last Name 2. Name of Applicant * First Name Last Name 3. How long have you known the applicant? 4. In what capacity do you know the applicant? (e.g Employer, Supervisor, Colleague, Friend) 5. If the applicant worked for you, please provide their job title, dates of employment and reason for leaving (if applicable) 6. Are you aware of any circumstances that might affect the applicant's suitability for employment? Yes No 7. Please provide any additional comments you feel are relevant to the applicant's character, work ethic or suitability for the role. 8. Based on your experience with the applicant, how much do you agree with the following statements? The applicant performs to a high standard Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant has a positive attitude toward their work Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant takes initiative when needed Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant makes sound and timely decisions Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant works well as part of a team Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant is punctual and reliable Strongly Disagree Disagree Neutral Agree Strongly Agree The applicant has a good attendance record Strongly Disagree Disagree Neutral Agree Strongly Agree 9. Approximate number of sick days the applicant took in the past year (If known) 0-2 days 3-5 days 6-10 days More than 10 days Not known Thank you!
