HUMAN RESOURCES / Reference Request Form /

STRICTLY CONFIDENTIAL

Referee Name

Referee Address

Ref: Letter Reference

Date

Dear Referee Name

Candidate Name

The above has applied for the position of Position Name in the Academic/Service Unit with the University, and has nominated you as a referee.

I would be grateful if you would complete the attached reference request form in as much detail as you are able to, appending any further comments you wish to add regarding the candidate’s suitability for the post in question. I enclose details of the post to assist you in this task.

I would like to thank you in advance for this reference and to assure you that your comments will be treated in confidence, subject to the requirements of the Data Protection Act. Our understanding of the Act is that you, as the author of the reference, are not obliged to disclose its contents to the subject of the reference. As the recipient of the reference, however, the University would normally be expected to disclose its contents if requested to do so by the subject, although not necessarily the identity of the author.

Please indicate on your reference if you consider there to be a compelling reason why the contents of the reference should not be disclosed to the subject. Please indicate also if you wish your identity, as the author of the reference, to be protected in the event of a request for disclosure.

I would be grateful if you could return the completed reference request form by return to the below e-mail address. If you have any problems or queries in this regard, please do not hesitate to contact me. My contact details can be found at the foot of this letter.

I would like to thank you in advance for this reference.

Yours sincerely

Insert Nameblock

Applicant’s Name: Applicant's Name

Post Applied For: Position, Academic/Service Unit

Current or previous employer’s please complete both Section A and Section B. If giving a personal reference, please complete Section B only.

SECTION A: Current or Previous Employer

Applicant’s last job title:

Start date: Leaving date:

If left, please give the reason for leaving:

Full-time Part-time if part-time please state number of hours

Salary and other benefits:

Main duties and responsibilities:

Work Record - please comment on the following:

Timekeeping and reliability:

Commitment to ensure that work is completed to the required standard and timescale:

Enthusiasm to learn and develop:

Would you re-employ this person? Yes No

If no, please give your reasons:

SECTION B: A copy of the job details for the vacant post is enclosed to help you comment on the following aspects of the applicant’s suitability for the post.

How long have you known the applicant?

Please comment on the applicant’s personal qualities (e.g. character, sense of responsibility, use of initiative, honesty):

Please comment on the applicant’s skills and experience for the advertised job, including aptitude for training:

Are you aware of any aspects of the applicant’s conduct, work or character which might detract from the required job performance?

Do you have any additional comments? (Please continue on a separate sheet if necessary)

Please tick if you wish either of these statements to apply:

I do not wish the reference to be disclosed without my permission

I do not wish my identity as author to be disclosed

Signature: Date:

Name: Position/relationship to applicant:

Name and address of Company/Organisation:

Telephone number: E-mail address:

Thank you for taking time to complete this reference.

©Human Resources, Newcastle University / Page 3 of 3 / Support Staff Reference Request & Form (to be completed in writing)
Form Updated February 2012