Employment Reference Request

Employment Reference Request Form

Name of person you are providing a reference for:

Are you related to this person?

Yes

What position did they hold?

Please state their employment dates below:

Date from:

Date To:

Please give a brief description of their role and responsibilities:

Is there any reason, to your knowledge, why the applicant may be unsuitable to work with children?

Yes

If Yes, please give details:

Has the applicant ever been subject to a formal disciplinary/capability procedure during their employment with you?

Yes

If Yes, please give details:

The above information is correct to the best of my knowledge and belief.

Name:

Email Address:

Address:

Telephone Number:

Date: