Reference Form

To be filled out by referee

Name of Applicant

Position Applicant is applying for

NE youth

NE tots

English classes

Other

If 'other' please state:

Name of Referee

Referee's email address

Referee's job title

Relationship with applicant

I confirm that I have known the applicant for a minimum of 3 years, and for a minimum of 5 years if they are over 25

I understand that the applicant is applying to a role that involves working with children or vulnerable adults

Would you support the applicant undertaking the position or role they are applying for?

Yes

No (please give more details below)

Yes, but I have some concerns (please give more details below)

If you do not think the applicant is suitable for the role, or have anything to share (positive or negative) please give more details here:

Do you know of any reason why we should not appoint the applicant to this possition or role?

Yes, I know of a reason why the applicant should not be given this position or role

No, I do not know of any reason why the applicant should not be given this position or role

If yes, please give more details here:

Is there anything else relevant about the applicant that we should know?

I confirm that, to the best of my knowledge, I have given accurate and fair information about the applicant

Our Privacy Policy applies.

Note: Please fill out the fields marked with an asterisk.

North Evington Free Church

Linden Street

Leicester

LE5 5EE