Employer Reference Enquiry

Private and Confidential

Name of applicant (BLOCK CAPITALS) Dates of Employment
From To

Job title of applicant whilst employed at your company

Honesty and integrity

Are you aware of anything detrimental regarding the applicant? Yes No

If yes, please give details

Reason for applicant leaving your company:

Would you re-employ the applicant? Yes No

If no, please give details

Was the applicant authorized to give advice or registered under Yes No

Financial Services Act (whilst working for your company)?

Attendance and timekeeping

Is the applicant generally reliable and punctual Yes No

If no, please give details

Please advise of any absence in the last 12 months of employment: No. No

Of Of
days occasions
Signed Date

Name (BLOCK CAPITALS) Position held at company (BLOCK CAPITALS)

Company telephone Number (Including STD Extension number (If applicable)

code)

Name of company and full address (BLOCK Company Stamp

CAPITALS)