Your Name:

Your Position:

Your Organization Name: (required)

1. Name of previous employee (required)

2. Employee job title at your organisation (required)

3. How long was the employee with your organization (required)

4. Was the employee reliable?
YesNo

5. Was the employee work satisfactory? (If no, please explain)
YesNo

6. Would you rehire this person?
YesNo

7. Do you have any concerns about employee working unattended with children? (If yes, please explain)
YesNo

8. Did the applicant maintain good relations with the co-workers and superiors?
YesNo

9. What are their strengths and weaknesses?

10. Any additional comments you would like to make?