Candidate Name *

First Name

Last Name

Reference Name *

First Name

Last Name

Dignity and respect *

Poor

Good

Excellent

Unable to comment

Compassion, empathy and ability to empower others *

Poor

Good

Excellent

Unable to comment

Motivation, commitment and attitude *

Poor

Good

Excellent

Unable to comment

Learning and development interests *

Poor

Good

Excellent

Unable to comment

Team working ability *

Poor

Good

Excellent

Unable to comment

Quality and safety *

Poor

Good

Excellent

Unable to comment

Education and qualifications *

Poor

Good

Excellent

Unable to comment

Overall Skills *

Poor

Good

Excellent

Unable to comment

Do you think the applicant is honest and trustworthy? *

Yes

No

Did you find the candidate to be reliable in carrying out her/his duties? *

Yes

No

Was the candidate’s time-keeping acceptable? *

Yes

No

Do you think that the candidate would be a suitable person to undertake this post? *

Yes

No

The information in this application form is true and complete. I agree that any deliberate omission, falsification or misrepresentation in the reference form will be grounds, rejecting/dismissal of this applicant . *

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