Locum Referance Form Name Of Candidate Organisation Name and Position Held When did they do locum or permanent work? Start Date End Date Candidate Ratings Ratings Excellent Very Good Good Satisfactory Unsatisfactory Diligence at work Reliability / Time-keeping Attendance Trustworthiness / Honesty Ability to work on own Ability to work in a team Work Performance Interpersonal Skills Enthusiasm Communication Skills Managerial Skills (where appropriate) Additional Information Reason for leaving Would you re-employ this person as a staff member YES NO Referee details Your Full Name Job title Organisation Contact Telephone Number Work Email I accept the terms of your Privacy Policy
