Agency Professional Reference for Employment

If you do have any issues or any further questions please let us know.

"*" indicates required fields

Name of applicant:*

Job Title

Name of Referee

Company Name

What is your relationship with the applicant?

Please give full dates (dd/mm/yy)

Is the applicant still currently employed by you?*

Start Date*

DD slash MM slash YYYY

End Date*

DD slash MM slash YYYY

(if you have confirmed the applicant is still working for you above, please use today's date)

What was the reason for them leaving?*

Was there an active, formal disciplinary record?*

Were there any safeguarding concerns during their employment with you?*

Was there a breach of the contract notice period?*

Was the contract terminated?*

Was a referral made to DBS?*

If yes to any of the above, please provide additional information

Any additional information or further comments you would like to make about the applicant:

Do you consent to us disclosing the information contained in this form should the candidate make a subject data access request under GDPR?*

Name Printed*

Name Signed*

Date*

DD slash MM slash YYYY

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