Employer Reference Request Form Refrence For: Refree name: Position Employed As: Organization Name: Employment START date: Employment END date: Referee Job Title: Please rate the following: Relationships with clients OutstandingGoodSatisfactoryPoor Professional knowledge and understanding OutstandingGoodSatisfactoryPoor Behaviour Management OutstandingGoodSatisfactoryPoor Work Performance OutstandingGoodSatisfactoryPoor Honesty / Integrity OutstandingGoodSatisfactoryPoor Punctuality OutstandingGoodSatisfactoryPoor Work Performance / Additional Comments Reason for Leaving? Would you reemploy? YesNo [group reemploy-no] If NO please state the reason why: Is there any reason why this candidate would not be suitable to work with clients? YesNo [group Suitableclients-yes] If YES please state reason why: [/group] [/group] I consent to this reference being passed onto third parties for the purpose of finding the above candidate work. YesNo [signature signature-727 cols:200 rows:100 background:#e8ebed] Print Name Date:
