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Reference Request Form

This document is an employment reference request form from HCA Healthcare UK sent to a reference for a candidate. It requests information about the candidate's dates of employment, job title, salary, the reference's position, reasons for leaving, whether they would rehire, disciplinary actions, health, duties, teamwork, performance, behavior, attendance, and an overall comment. The reference is asked to sign and provide company information to confirm the accuracy of the details.

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okogeabisaac
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13 views

Reference Request Form

This document is an employment reference request form from HCA Healthcare UK sent to a reference for a candidate. It requests information about the candidate's dates of employment, job title, salary, the reference's position, reasons for leaving, whether they would rehire, disciplinary actions, health, duties, teamwork, performance, behavior, attendance, and an overall comment. The reference is asked to sign and provide company information to confirm the accuracy of the details.

Uploaded by

okogeabisaac
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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2 Cavendish Square

London, W1G 0PU


T +44 (0) 20 7616 4848
www.hcahealthcareuk.co.uk

Employment Reference Request

Employee Name

In what capacity do you know HR Direct/Indirect Line Manager Colleague/Peer


the candidate?
Dates of candidate's
From To
employment:

Name of Company where you


worked with employee:

Candidates’ job title while in


your company:

Candidates' annual salary


£
paid:

Your position when working


with the candidate:
Reason for candidate leaving
the employer:

Would you re-employ the Yes No Company policy not to re-employ


candidate?
Please comment if you answered no:

Did the candidate report


Yes No
directly to you?
If they did not, please could you detail below your working
relationship with the candidate?

Has any disciplinary action Yes No


been taken against the
If yes please give details:
candidate whilst in your
employment?

To the best of your knowledge Yes No


is the candidate in good
If no, please give details:
health?

Please give brief details of the candidate's duties in your employment:

Teamwork is paramount to the success of our business. In your opinion, has the candidate ever
experienced any problems regarding relationships with others?

HCA Healthcare UK is a trading name for HCA International Limited. HCA International Limited is a private limited company registered
in England and Wales. Registered No.03020522. The registered office address is situated at 2 Cavendish Square, London, W1G 0PU

Blossoms Healthcare HCA Healthcare UK Joint Ventures London Bridge Hospital Roodlane Medical The Harley Street Clinic The Lister Hospital The Portland Hospital The Princess Grace Hospital The Wellington Hospital
2 Cavendish Square
London, W1G 0PU
T +44 (0) 20 7616 4848
www.hcahealthcareuk.co.uk

Please rate the candidate on the following:

I No
Excellent Good Average
comment

Performance in their role

Behaviour and attitude towards colleagues,


external suppliers and/or patients

Achievement of responsibilities

Attendance at work, please explain if average:

Attendance and sickness record at work (please state number of sickness periods in the last 12
months, number of days each period and reason for sickness):

Please comment on the overall conduct of the candidate:

confirm that the information provided above is accurate

Signed:

Name:

Designation:

Company stamp (please provide your company stamp or ensure that the form is sent from your
work email)

These details will only be used in relation to this job application.

Please note: The candidate has a right under The Data Protection Act to request a copy of this reference and we
as the prospective employer may be obliged to supply a copy if requested.

HCA Healthcare UK is a trading name for HCA International Limited. HCA International Limited is a private limited company registered
in England and Wales. Registered No.03020522. The registered office address is situated at 2 Cavendish Square, London, W1G 0PU

Blossoms Healthcare HCA Healthcare UK Joint Ventures London Bridge Hospital Roodlane Medical The Harley Street Clinic The Lister Hospital The Portland Hospital The Princess Grace Hospital The Wellington Hospital

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