Reference Request Reference Form Please provide your name Please provide your company name (if applicable) What is the name of the person you give the reference for? When did this person start working for you? When did this person stop working for you? Why did this person stop working for you? Please describe this person's job responsibilities On a scale of 1 to 5 (with 5 being the best) how was the individual's punctuality? * On a scale of 1 to 5 (with 5 being the best) how was the individual's attitude towards work? * On a scale of 1 to 5 (with 5 being the best) how would you rate the individual's appearance attending work? * On a scale of 1 to 5 (with 5 being the best) how would you rate the individual's work performance? * On a scale of 1 to 5 (with 5 being the best) how would you rate the individual's character? * Please use this text box to add any additional comments you would like to make Would you re-employ the individual? * No Yes If you are human, leave this field blank. Submit