Details of person completing the reference
Your Name
Company
Position
Contact Number
Candidates details
Candidate's Name
Position held whilst working for you
Dates employed  From:  To:
Evaluation of candidate's abilities
  Very goodGoodSatisfactoryUnsatisfactory
Quality of work
Output / Productivity
Conduct
Attendance / Time keeping
Teamwork
Employment
Reason for leaving employment
Would you re-employ them?  Yes:  No:
To the best of your knowledge were they honest and trustworthy?  Yes:  No:
Comments
Are there any other comments you would like to make?