Name* First Last Referee Name*Referee Email Address* Referee's Company / Organisation*Company / Organisation Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Company Telephone Number Phone*What is/was your relationship to the applicant?*How long have you known the applicant?*In what capacity do you know the candidate? (Friend or Employer)*Date Employment Commenced* Date Employment Ceased* Position held with the company*Role and Responsibilities*Reason for leaving and final salary*Was the candidates timekeeping of a good standard?* Yes No Sometimes Was the candidates attendance of a good standard?* Yes No How many days sickness did the candidate have in the last 2 years, whilst in your employment?*How well does the candidate meet the criteria?*Would you consider the applicant able to maintain confidentiality?* Yes No (please provide more details in the box below) If no - please provide reasons whyHas the applicant ever been subject to a formal disciplinary procedure during their time with you?* Yes No If yes - please provide reasons whyHM Government guidelines "Working Together to Safeguard Children" illustrate the need for individuals and organisations to work together in safeguarding children. Safeguarding children is everyone’s responsibility. Is there anything you should tell us about the applicant’s suitability to work with children?* Yes (please provide more details in the box below) No If you have answered yes to the question above, please provide more details hereTo your knowledge or experience, is there any reason why this applicant should not work in an Early Years setting?* Yes No If you have answered yes to the question above, please provide more details hereWould you re-employ the applicant?* Yes No (please provide more details in the box below) If you have answered no to the question above, please provide more details hereDo you give permission for these details to be disclosed to the applicant?* Yes No Confirmation* I confirm that to my knowledge all the information supplied is correct: I can not confirm that to my knowledge all the information supplied is correct: Date*
