Reference Request Form

Candidate name

Does the candidate work for you or your organisation, or have they done so in the past?

Please state the candidates start date with the organisation

Please state the candidates leaving date with the organisation (if applicable)

Candidate Job Title

Candidate reason for leaving

If other, please specify

How long has the candidate been known to you/your organisation?

How many sick days did the candidate have in your organisation for the total employed
period?

How many occasions of sickness did the candidate have in your organisation for the total
employed period?

How many days was the candidate late in your organisation for the total employed
period?

Do you have any comments about the candidates suitability or unsuitability for this post?

I declare that the information provided in this form is true.
I agree (your name)

I consent to this reference being disclosed to the Candidate

Your Name
Your Position/Occupation
Your Organisation Name

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