Reference Request Form

Reliability + Punctuality Unsatisfactory Satisfactory Good Very Good Excellent

Is this person part of any current disciplinary procedure or investigation Yes No

Subject to company policy would you re-employ this individual? Yes No

If not why not?

Do you have any other comments that might assist us when assigning this person?

Do you know of any reason why this applicant would not be suitable to work or have contact with vulnerable people, including children, within a care organization?