Reference Form Promise Care Services Your Personal InformationYour Name First Last Job Title Your Email Address Enter Email Confirm Email Date of Birth MM slash DD slash YYYY Specific dates of employment: (Please use exact dates e.g From 04 Jan 2010- 01 Dec 2015) Job Title Nature of work, Specific duties, responsibilities:Reason for leaving employment? If dismissed, please supply details:Was applicant honest and trustworthy at all times? Yes No If no please supply full details:During employment was applicant the subject of a Disciplinary procedure? Yes No If yes, please supply full details and outcomeWould you re-employ applicant? Yes No If no, please state reasons why:Do you have any other information you feel would be relevant to an employer?General Conduct Excellent Good Satisfactory Below Average Poor Work Performance Excellent Good Satisfactory Below Average Poor Attitude to Work Excellent Good Satisfactory Below Average Poor Initiative Excellent Good Satisfactory Below Average Poor Time Keeping Excellent Good Satisfactory Below Average Poor Relationships with: Colleagues: Excellent Good Satisfactory Below Average Poor Relationships with: Customers: Excellent Good Satisfactory Below Average Poor If you indicated applicant is “Below Average” or “Poor” for any category, please state your reasons below:Company Name Position Held Date MM slash DD slash YYYY Signature(Required)CAPTCHA Δ
