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Agency Reference
1
Part 1
2
Part 2
3
Part 3
Candidate Name:
*
Establishment Name:
*
Position Candidate Held:
*
Dates of knowing the candidate:
Date From
*
Date Too
*
Reason for leaving:
Nature of employment:
*
Permanent
Contract
Supply Agency
In what professional capacity do you know the applicant?
Timekeeping/Punctuality
*
Outstanding
Very Good
Good
Satisfactory
Un-satisfactory
N/A
Reliability
*
Outstanding
Very Good
Good
Satisfactory
Un-satisfactory
N/A
Professionalism
*
Outstanding
Very Good
Good
Satisfactory
Un-satisfactory
N/A
Next
Would you use this candidate again to represent your agency?
*
Yes
No
Have there been any safeguarding concerns relating to this person?
*
Yes
No
Is there any reason this person should not work with young people?
*
Yes
No
Can we share this with the person in question should they request to see it?
*
Yes
No
If no, please give more information regarding this:
Additional comments:
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Full Name
*
Your Profession:
*
Signature
Date
*
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