Agency Statement Request In writing your reference, please note that, in order to protect children, the post for which application is made is exempt from section 4(2) of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975. It is not, therefore, in any way contrary to the Act to reveal any information you may have concerning convictions/bindovers/cautions which would otherwise be considered as ‘spent’ in relation to this application and which you consider relevant to the applicants suitability for employment. Any such information will be kept in strict confidence and used only in consideration of his/her suitability. Candidate name * Date of Candidate Registration: * Date of Birth: * What dates did the applicant work for you Company / Agency Name * Employment Start Date: * Employment End Date: * Approximate number of days worked * Position Held * General Feedback * Please SelectExcellentGoodSatisfactoryUnsatisfactory Reliability / Honesty * Please SelectExcellentGoodSatisfactoryUnsatisfactory Punctuality * Please SelectExcellentGoodSatisfactoryUnsatisfactory Are you aware of any issues with the applicant in relation to Safeguarding & Child Protection? * Yes No If YES, please provide details Would you re-employ? * Yes No If NO, please give a reason Signature * signature keyboard Clear Position * Referee Email * Date * Are we able to disclose this reference to the above named applicant * Yes No Can this reference be given to the potential employer * Yes No Submit If you are human, leave this field blank.
