Reference Request - St Cyprian's Greek Orthodox Primary Academy

Reference Request Form

It would help considerably in assessing the suitability of the candidate that you have been contacted about if you could complete the form below for us.

As part of our regulatory standards, we are required to verify the authenticity of all written references. The appointing Manager will therefore make a brief telephone call for this purpose.

Thank you for you assistance with our recruitment process.

Subject of Reference
Please give us details of the applicant
Name*
First Last
Dates with your organisation*
Capacity in which employed / job title*
Salary / wage rate*
How long have you known the above person?*
In what capacity have you known this person?*
Applicant's Attendance Record
Applicants Attendance Record*
Number of days and number of occasions absent in last full year or, if employed for less than one year during the period of employment (excluding maternity- related absence)
Parental Leave Record
Accepted file types: pdf, Max. file size: 300 MB.
Please upload or email us a copy of the applicant's parental leave history, including details of their remaining entitlement. Please send as a PDF file.
Applicant's Disciplinary Record
Formal Warnings*
Does the applicant currently have any formal warnings recorded against them under your performance, disciplinary, sickness or other management Policy?
If YES, please state reasons and relative dates*
Pending action at the time of leaving*
If the applicant has left your employment was any management action pending or was the applicant the subject of a management investigation at the time he/she left your employment?
Pending Management Action*
Is any management action pending or is the applicant currently the subject of a management investigation?
If YES, please give details*
Child Protection Issues*
Has the applicant ever been subject to any sort of investigation that focussed on child protection issues?
Action Taken regards to child protection issues*
If yes, was any action taken as a result of the investigation? If YES, please contact us confidentially with further information.
Any Convictions*
Are you aware of any convictions (including spent convictions), cautions, warnings and reprimands recorded against him/her?
Untitled*
If yes, please specify. This post is exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974. It is therefore not contrary to the Act for you to reveal such information.
Applicant's Performance & Suitability
Please give a short summary of the applicant's attitude to work and quality of performance whilst in your employment, highlighting any particular strengths or weaknesses. If the post applied for involves working with children or vulnerable adults, please comment specifically on the individual’s motivation as well as their ability to relate to and work with children. You should also comment on their understanding of their own duty of care and duty to maintain professional boundaries.
Summary of attitude and performance*
Reason for Leaving

If the applicant is no longer in your employment
Would you employ this person again?*
Following your usual recruitment and selection procedures, would you consider employing this person again?
Additional Comments
Do you have any further information or comments which you wish to offer about the applicant's suitability for this particular post?
Referee Details
Please give us your details below
Name*
First Last
Your Signature*
Please write your signature here either using your mouse (if on a desktop pc) or using your finger or stylus (if using a mobile device).
Position*
Date*
DD slash MM slash YYYY
Phone*
Extension Number
Email*
Enter Email Confirm Email
Name of Organisation*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Confidentiality*
Thank you for your co-operation in completing this request. Please note that while our general policy is to allow open access to personal files, confidentiality will be respected if you indicate here that you are giving this reference in confidence.

Reference Request Form

Subject of Reference

Applicant's Attendance Record

Applicant's Disciplinary Record

Applicant's Performance & Suitability

Referee Details

Get In Touch