Employment Reference

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Applicants Full Name *

Position Applied For

The above-named person has applied to work at Lifeline Care Services and has given your name as a referee in accordance with the protection of vulnerable adult’s policy. We would be grateful if you could comment on his/her suitability for the position. Any information provided will remain confidential.

Does/did the applicant work for your Company? *

• Yes
• No

If yes, please give the applicant’s starting and leaving dates (if applicable) *

What is/was the applicant’s job title at your Company? *

What are/were the applicant’s main job duties? *

What is your assessment of the following elements in relation to the applicant?

Quality of Work *

• Excellent
• Good
• Fair
• Poor

Quantity of Work *

• Excellent
• Good
• Fair
• Poor

Dedication to the job *

• Excellent
• Good
• Fair
• Poor

Ability to work without supervision *

• Excellent
• Good
• Fair
• Poor

Working Relationships *

• Excellent
• Good
• Fair
• Poor

Do/did you find the applicant to be honest and trustworthy? *

• Yes
• No

Do/did you find the applicant to be reliable in carrying out his/her duties? *

• Yes
• No

Is/was the applicant’s time-keeping satisfactory? *

• Yes
• No

Does/did the applicant have any disciplinary warnings during his/her last 12 months’ employment with your Company? If so, please comment, if possible, on the nature of these warnings: *

• Yes
• No

How many days absence from work has the applicant had during his/her last 12 months employment with your Company?

What was the applicant’s reason for leaving your Company? (if applicable)

Do you think the applicant would be a suitable person to perform the job described above? *

• Yes
• No

Do you have any further comments to make as regards the applicant’s suitability for employment as described by the job description?

Referee Details

Name *

First

Last

Email *

Position *

Organisation/Company *

Signature *

Clear Signature

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