Current/Previous Employer Reference Request Form

Thank you for taking the time to complete this brief form. Please add the basic details as requested, the candidates full name and date of birth is on the email sent with this link. Simply tick the relevant boxes that apply to the candidate and add comments in the final box if you wish. Once completed, please click the ‘submit’ button.

If you have any questions or concerns please contact us via info@familysupportwales.co.uk

Thank you for your time.
Your name*
Your job title or designation*
Employee's name*
Employee's date of birth
Employment date: FROM*
DD slash MM slash YYYY
Employment date: TO*
DD slash MM slash YYYY
Employee's Role
Is the candidate involved in a disciplinary process?*
- Yes
- No
Disciplinary process information
Please provide details of the disciplinary process the employee is involved in.
Is the candidate subject to child or adult safeguarding concerns?*
- Yes
- No
Child or adult safeguarding concerns information
Please provide details of the child or adult safeguarding concerns relating to the employee
Would you employee this person again?*
- Yes
- No
Sick days*

Estimate the amount of sick days accumulated by employee.
Additional information
Privacy*
- By using this form you agree with the storage and handling of your data by this website.
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Comments
This field is for validation purposes and should be left unchanged.

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