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Candidate Reference Form
MBR Dental Candidate Reference Form
Please complete all fields.
Candidate Name
*
In what capacity do you know the applicant?
*
How long did this applicant work alongside you?
*
What was their position?
*
What was their reason for leaving, if known:
*
Please tick which box accurately applies to the applicant:
Work Performance
*
Excellent
Good
Satisfactory
Below Average
Poor
General Conduct
*
Excellent
Good
Satisfactory
Below Average
Poor
Attitude to Work
*
Excellent
Good
Satisfactory
Below Average
Poor
Initiative
*
Excellent
Good
Satisfactory
Below Average
Poor
Time Keeping
*
Excellent
Good
Satisfactory
Below Average
Poor
Relationships with Colleagues:
*
Excellent
Good
Satisfactory
Below Average
Poor
Relationships with Customers:
*
Excellent
Good
Satisfactory
Below Average
Poor
During their employment did you have any reason to doubt the applicant’s honesty?
*
Yes
No
Subject to a suitable vacancy and policy permitting would you re-employ the applicant?
*
Yes
No
You agree for this reference to be passed onto prospective employers.
*
Yes
No
Click below and enter todays date.
*
MM slash DD slash YYYY
Your Name
*
Email
*
Phone
*
Company Name
*
Position Held:
*
Please add any addition comments (optional)
By ticking the box below you confirm that all the above information is accurate and correct and typing your name above acts as your signature.
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