Reference Request

In what capacity do you know the Candidate?(Required)

Your Job Title(Required)

Their Job Title(Required)

Their Starting Date:(Required)

Their Leaving Date:(Required)

Salary:(Required)

Additional Benefits:

Reason for leaving:(Required)

Sick absence during the last two years - Number of days within the last 24 months:(Required)

If possible, please state nature of illness:

If you answered yes to either question above, please provide details:(Required)

If any of the above are rated poor, please explain why:

If yes please provide details:

Is there any additional information relevant to this person’s suitability for working within Simon Community?

Date:(Required)

Contact phone number:(Required)

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Reference Request Form