Reference Form - Halo Staffing

Applicant First Name(Required)

Applicant Last Name(Required)

Please confirm dates of employment

Start date(Required)

Are they still working for you?(Required)

Finish date

Please confirm your relationship to the applicant:(Required)

Please confirm the applicants reason for leaving (if known)

How many days was he or she absent due to sickness in the last 12 months?

Are there any warnings on the applicants record?

Please provide details

Is the applicant currently under investigation for any matter (including conduct, capability or performance) under your employment policies?

Please provide details

Are you aware of any recent/outstanding allegations that were made against the applicant that related to safeguarding issues/referrals (including any referrals to the DBS)

Please provide details

Are there any reasons why you believe the applicant would be unsuitable to work with vulnerable adults or children?

Please provide details

Are there any other reasons or circumstances, which would make it undesirable for us to consider this applicant?

Please provide details

Please indicate ratings for the following

Honesty

Reliability

Timekeeping

Documentation

Quality of work

Quantity of work

Relationships with others

Work without supervision

Declaration: The answers given in the above have been given in good faith and are correct to the best of my knowledge and belief.

Referee First Name(Required)

Referee Last Name(Required)

Referee Email Address(Required)

Position(Required)

Company Name(Required)

If using a non-professional email, i.e. Hotmail, Gmail etc please include a letterhead, company stamp, business card or ID card as evidence of your authority within your organisation.(Required)

Max. file size: 64 MB.

Date(Required)