Eurocom C.I. Questionnaire

*Employment Reference Request Form *Please complete all fields *Details provided are in the strictest confidence

Candidate Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Please give details of the candidates full postal address, including postcode, whilst they were in your employment.
Work History
What was the candidate's Job Title whilst in your employ?

Please state the full Job title at the time the candidate left your employment.
Start Date / DD / MM YYYY
Please give the precise date of when the candidate started employment with your company.
End Date / DD / MM YYYY
Please give the precise date of when the candidate left employment with your company.
Would you re-employ candidate? Yes No
If No - please give reason
Did the candidate leave of their own accord? Yes No
Please state reason for leaving if known:
The candidate's work performance was: Very Good Good Fair Poor Very Poor
Would you consider the candidate to be trustworthy and honest? Yes No Not Known
Please provide further comment on the candidate's trustworthiness and honesty if desired:
Please indicate total number of sick days taken whilst in your employ:
On how many occasions were sick day(s) taken?
About Your Company
Company Name *
Your name *
Your position *
Your Telephone number *

Please enter your full number without spaces.
Your email address *
Type the letters you see in the image below.