Job Reference Request: Support Staff Step 1 of 2 50% Name of Applicant:(Required) First Name Surname Name of Referee:(Required) First Name Surname Are you a representative of the Applicant’s current or previous employer?(Required) Yes, I am a representative of the Applicant’s current or previous employer No, I am giving a reference in another capacity What is the name of your Organisation/School?(Required) What position do you hold?(Required) How long did you line manage / work with the Applicant?(Required) Please confirm the Applicant's job title and/or duties:(Required) Dates of employment - From:(Required) Day Month Year Dates of employment - To:(Required) Day Month Year If the Applicant has ceased employment with you, please confirm the reason for the termination of the Applicant's employment: If the Applicant was dismissed, please explain the reason for the Applicant's dismissal and the surrounding circumstances: Please confirm the Applicant's current salary (or their salary on termination):(Required) What is your relationship to the Applicant?(Required) How long have you known the Applicant?(Required) Based on your knowledge and experience of the Applicant, do you believe that they are suitable for the post applied for (as described in the job description and person specification you received)?(Required) Yes No If not, please give reasons for your answer:Based on your knowledge and experience of the Applicant, do you have any reason to believe that they are unsuitable to work with children?(Required) Yes No If yes, please give reasons for your answer:Please include any other information which you consider may be relevant to the Applicant’s application:Please rate the Applicant against the following criteria:Attitude to work Needs substantial development Needs development Acceptable Strong Outstanding Attendance Needs substantial development Needs development Acceptable Strong Outstanding Reliability Needs substantial development Needs development Acceptable Strong Outstanding Working relationships with colleagues Needs substantial development Needs development Acceptable Strong Outstanding Commitment Needs substantial development Needs development Acceptable Strong Outstanding Has the Applicant been the subject of disciplinary proceedings (whether formal or informal) during the last 12 months of their employment?(Required) Yes No If yes, please provide details of the allegation(s) against the Applicant and the outcome of the proceedings:Has the Applicant been the subject of disciplinary proceedings (whether formal or informal) involving issues related to the safety and welfare of children or young people?(Required) Yes No If yes, please provide details of the allegation(s) against the Applicant and the outcome of the proceedings:If applicable, please provide details of any allegations or concerns that have been raised (whether formally or informally) about the Applicant which relate to the safety and welfare of children or young people.(Required)With reference to the job description and person specification you received, are you satisfied that the Applicant has the ability and is suitable to undertake this role?(Required) Yes No If not, please give specific reasons for your concerns:Are you completely satisfied that the Applicant is suitable to work with children?(Required) Yes No If not, please give specific reasons for your concerns:Would you be willing to re-employ the Applicant?(Required) Yes No If not, please explain why:Any other comments: Signature and ConsentYour signature:(Required)Consent(Required)In submitting your personal data via this form, you consent to being contacted via the details provided so that you can be responded to if necessary. A backup of your data will be held, but only authorised individuals will be able to access your data. If you would like your data to be removed, please email support@thewebkitchen.co.uk I agreeNameThis field is for validation purposes and should be left unchanged.
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