Applicant full Name
Your First Name Your Last Name Your Job Title Your Work Email Your Work Telephone number Company Name & Address where you worked with applicant Applicant Job title Relationship with applicant Is the Applicant Still employed YesNo Date employed from Date employed to Reason for Leaving (if applicable) How many days was the applicant absent (including period of sickness) during the last 12 months of employment: Would you Re-employ applicant, if answer is No please provide further information below? YesNo Comments/Further information Please comment on the following below : General Conduct ExcellentGoodSatisfactoryPoor Timekeeping ExcellentGoodSatisfactoryPoor Communication skills ExcellentGoodSatisfactoryPoor Relationship with colleagues ExcellentGoodSatisfactoryPoor Relationship with customers/patients/service users ExcellentGoodSatisfactoryPoor Are you aware of any proceedings, Policy investigations or disciplinary action? Declaration I declare that to the best of my knowledge the information I have given in this reference is correct and complete
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