CONFIDENTIAL REFERENCE QUESTIONNAIRE

Name :

Post Applied For :

Background How long have you known candidate and in what capacity?

Personnel Matters Candidate’s position Dates of employment with you (month and year) Extent of candidates duties

During his or her employment did the candidate perform his or her duties to your satisfaction?

If you were dissatisfied, please explain the reasons for this. During his or her employment did the candidate present him or herself professionally with colleagues and those he or she dealt with? Salary Sick leave : how many days was the candidate off work sick over the last 2 years?

Parental Leave taken since 15th December 1999. Do you believe that the candidate is physically and mentally fit to work in a school environment? If not, please elaborate, including where appropriate any reasonable adjustments which were made during employment to enable the candidate to perform his or her duties.

Suitability for the post Do you believe that the candidate has the ability and is suitable to undertake this position? What makes the candidate particularly suitable for this position?

If you do not consider the candidate to be suitable, please elaborate.
How does the candidate meet the job description?

If you do not consider the candidate able to meet the duties of the job description, please elaborate.

Suitability to work with children Are you completely satisfied that the candidate is suitable to work with children? If you are not satisfied, what are your concerns and the reasons why you think the candidate might not be suitable?

Disciplinary Record and Child Protection Concerns

Has the candidate been/was the candidate subject to any disciplinary procedures where the disciplinary sanction is still current?

If so, please give details.

Has the candidate been/was the candidate subject to any disciplinary procedures relating to the safety and welfare of children or young people including any where the disciplinary sanction has expired or where the allegation was unfounded and/or no disciplinary sanctions were imposed?

If so, please give details.

If the candidate’s role involved no contact or responsibility for children or young persons, please answer Not