Reference Request 1 Details2 Assessment3 Declaration CandidateNI NumberCapacity in which you know the candidate*Length of time you have known the candidate*Dates in your employmentFrom: Date Format: DD slash MM slash YYYY To: Date Format: DD slash MM slash YYYY How was the employment terminatedResignationRedundancyDismissalRetirementPlease provide reason for dismissalWould you re-employ this candidate?YesNoIf no, please give details:Is there a current disciplinary record for this candidateYesNoIf yes, please give details:To your knowledge has the candidate had any vehicle accidents which led to any insurance claims as a result of their driving whilst on duty?YesNoIf yes, please give details:Please indicate the sick record for the past 12 months*Number of Days & Number of EpisodesIs there a current live period of sickness review for this individual?E.g. 6 month informal review.YesNoTotal length of reviewExpiry date of review Date Format: DD slash MM slash YYYY AssessmentPlease assess the candidate in relation to the following:Honesty & Trustworthiness*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Time Keeping*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Conduct*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Performance in post*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Ability to work with others*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Ability to work unsupervised*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Management of staff (if applicable)*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Professional IT ability (if applicable)*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Acceptance of responsibility*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Reliability under pressure*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Ability to carry out instructions*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Written communication skills*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Verbal communication skills*ChooseGoodSatisfactoryUnsatisfactoryNot ApplicableComments:Do you know of any reason why this person should not work with vulnerable adults and/or children?* DeclarationI confirm that I am authorised to give reference details on behalf of:Company/OrganisationNamePositionDate Date Format: DD slash MM slash YYYY Telephone Number