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Employment Reference Form
Woodentots Nursery
Employment Reference Form
Please leave blank:
Candidate Name:
Dates of employment
Date from:
Date to:
Please give a brief description of their role and responsibilities
Details:
Is there any reason, to your knowledge, why the applicant may be unsuitable to work with children?
Yes
No
If Yes, please give details:
Has the applicant ever been subject to a formal disciplinary/capability procedure during their employment with you?
Yes
No
If Yes, please give details:
Please rate the applicant against the following criteria:
The applicant's health, attendance and punctuality are excellent:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is strictly honest, conscientious and discreet:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is highly competent in all elements of the relevant standards:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant has good levels of literacy and numeracy:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is able to exercise appropriate control and management of children's behaviour:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant has good listening and communication skillls:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is able to explain instructions clearly and is able to clarify:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is professionally discreet and able to respect confidentiality:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant is able to engage with children and act as a positive role model:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
The applicant has developed good working relationships with customers:
Strongly Agree
Agree
Disagree
Strongly Disagree
Not Known
Please give any comments you wish relating to the above criteria:
Do you know of any other factors concerning the applicant which might cause their fitness for working with young children to be questioned:
Yes
No
If Yes, please give further details:
Why did the applicant leave your employment?
Would you re-employ the applicant?
Yes
No
If No, please give your reasons:
The above information is correct to the best of my knowledge and belief.
Name:
Address:
Tel Number:
Date:
Submit
Woodentots Nursery, HMS Collingwood, Newgate Lane, Fareham, Hampshire, PO14 1AS - Tel. 01329 332532
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