• Name of candidate*
    0
  • Organisation where candidate worked
  • Organisation name and position held*
    0
  • When did they do locum or permanent work?
    1
  • Start date*
    2
  • End Date*
    3
  • Candidate Ratings
    4
  • Ratings* Excellent Very Good Good Satisfactory Unsatisfactory
    Diligence at work
    Reliability / Time-keeping
    Attendance
    Trustworthiness / Honesty
    Ability to work on own
    Ability to work in a team
    Work Performance
    Interpersonal Skills
    Enthusiasm
    Communication Skills
    Managerial Skills (where appropriate)
    6
  • Additional Information
    7
  • Reason for leaving*
    8
  • Would you re-employ this person as a staff member*
    Yes
    No
    9
  • Referee details
    10
  • Your full name*
    11
  • Job title*
    12
  • Organisation*
    13
  • Contact telephone number*
    14
  • Work email*
    15
  • *
    I am happy to be contacted for any further clarification/information
    16