Reference Request Form

Candidate Name *

Candidate Job Title *

Current Salary/Pay scale *

Dates of Employment: From *

Dates of Employment: To *

Main Duties and responsibilities *

Assessment *
Please give your assessment of the candidate’s professional abilities below.

a) Would you re-employ? *

Yes
No

(If no please provide further information)

b) Are you aware of any reason the candidate should not be employed? *

Yes
No

(If Yes please provide further information)

c) Why did this candidate leave your employment? *

d) In Years, how long have you known this candidate? *

In what capacity? *

e) Number of days sickness in the last 12 months of employment (excluding absence related to maternity) *

f) Has there ever been any disciplinary action taken against the candidate? *

Yes
No

What was the reason for disciplinary action?
Please include:- details of any disciplinary procedures the candidate has been subject to in which the disciplinary sanction is current;- details of any disciplinary procedures the candidate has been subject to involving issues related to the safety and welfare of children or young people, including any in which the disciplinary sanction has expired, and the outcome of those; and,- details of any allegations or concerns that have been raised about the candidate that relate to the safety and welfare of children or young people or behaviour towards children or young people, and the outcome of those concerns e.g. whether the allegations or concern was investigated, the conclusion reached, and how the matter was resolved.

When did it occur?

Additional *
If you answer NO to question a) or YES to question b) and f) please provide additional details.

Please list the candidate’s main strengths and weaknesses *

Suitability of the candidate to this position *
Please comment on the suitability of the candidate to this position. You should include the candidate’s current knowledge compared to that required for this post, personal attributes and potential to develop in this role. A job description, including a person specification is attached to help you provide the comprehensive assessment.

Suitability to work with children

Do you know of ANY reason why this applicant may not be suitable to work with children? *

Yes
No

If yes please give details

Under the Data Protection Act 1998, where there has been a Subject Access Request, your consent is required before we may disclose to the data subject the information contained in this reference

I do/do not agree to the disclosure of the information contained in this reference *

I do
I do not

Full Name *

Position *

Telephone *

Email *

Date *

Relationship to candidate (i.e. Manager) *

Do you wish to talk further to the Head Teacher *

Yes
No

Please ensure the reference is accurate and does not contain any material misstatement or omission.

The Recruiting manager may contact you if clarification is required on any point, if there has been an omission and if the candidate is successful in order to confirm identity.

Thank you for taking the time to complete this reference

Reference Request Form

Reference Request Form

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