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Applicant's Name
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Applicant's Position Held
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Date From
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Date To
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DD slash MM slash YYYY
Reason for Leaving
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Would you Rehire?
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Yes
No
If No please state your Reason
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In your experience, how would you rate the Applicant's Honesty?
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Trustworthiness?
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Knowledge of the Job?
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Job Skills?
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Fair
Good
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Work Ethic?
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Fair
Good
Exceptional
Work Quality?
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Poor
Fair
Good
Exceptional
Quantity of Work?
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Good
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Ability to work with others?
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Fair
Good
Exceptional
Initiative?
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Poor
Fair
Good
Exceptional
Dependability?
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Fair
Good
Exceptional
Attendance?
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Poor
Fair
Good
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Other General Comments
Referee's Name
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Please tick below to acknowledge that the above name will be used as your Electronic Signature for this form.
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