Reference Request 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 firstname.lastname@example.org 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 RoleIs the candidate involved in a disciplinary process?* Yes No Disciplinary process informationPlease 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 informationPlease provide details of the child or adult safeguarding concerns relating to the employeeWould you employee this person again?* Yes No Sick days* Estimate the amount of sick days accumulated by employee.Additional informationPrivacy* By using this form you agree with the storage and handling of your data by this website. More information >> CommentsThis field is for validation purposes and should be left unchanged.