Reference Request Form

The person named below has applied for the stated post within our organisation and has given your name as a referee. It would be greatly appreciated if you could answer all relevant questions, sign and date the form, and submit as soon as possible.

General Information

Employment Information


Assessment of Performance

Please rate the person on the following:

Other Information

Set a reminder:

Data Protection

If the applicant is successful the information will be held on file for the duration of their employment. If the applicant is unsuccessful the information will be held on file for a maximum of twelve months and then destroyed.