EMPLOYMENT REFERENCE CHECK FORM

Name of the employee: James Obuya

Former employer organization name: Mater Hospital, Nairobi

Person & title of person providing

Reference info:

Dates of employment: Start: dd-mm-year End: dd-mm-year

Job Title in previous organization:

His/ Her Salary details:

Reporting Head:

Reasons for Leaving. Was proper notice given?

Was performance acceptable?

Yes No

Comments:

Would you Re-hire him/her if opportunity arises? YES/NO (If no please explain)
Yes No

Would you like to give any other information about his / her character, conduct and
general fitness?
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“THANK YOU FOR YOUR TIME AND VALUABLE INPUT”

Verified By

Name:

Designation: