Strictly confidential

Your details

Your Name:
Your Email:
Your company:

About the employee

Full name:
National insurance:

Employment details

Dates of employment: Start: Leave:
Reason for Leaving:
Would you re-employ this person? If no is this Company Policy?

Assessment

Honesty/Trustworthiness
Attendance/Timekeeping
Reliability
Health
Sobriety
Suitability for Position*