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 birthEmployment date: FROM* Employment date: TO* Employee's RoleIs the candidate involved in a disciplinary process?*YesNoDisciplinary process informationPlease provide details of the disciplinary process the employee is involved in.Is the candidate subject to child or adult safeguarding concerns?*YesNoChild or adult safeguarding concerns informationPlease provide details of the child or adult safeguarding concerns relating to the employeeWould you employee this person again?*YesNoSick 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 >> EmailThis field is for validation purposes and should be left unchanged.