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If you could please take the time to complete the form below, answering as accurately as possible:

1. Applicant Name:

2. Employed From:

3. Employed to:

4. Job Title

2. Would you please comment on the following characteristics of the applicant whilst in your employment?

(a) Honesty

(b) Trustworthiness

(c) Attendance Record

(d) Timekeeping

3. In your view was the work performance of the applicant satisfactory?


If no, please comment

4. Why did the Applicant leave your employment?

5. Are there any additional factors you would wish to make us aware of in relation to the applicant’s suitability for employment?

I declare that I have read all the information in this application, and I have been made aware of my 'terms of engagement' as a temporary worker.

I have read and understood