A21 - Internship Reference Forms Page  1  

WORK OR ACADEMIC REFERENCE FORM Applicant's Name:

Applicant's Email: Applicant's Phone Number:

Name of Referee:

Email:

Employer &Title:

Phone Numbers: Work: Mobile:

What is your relationship with the applicant (Colleague, friend, family member) and how long have you known them?

In what context do you know this applicant? (Work, Social, Family)

 

A21 - Internship Reference Forms Page  2  

Please tick the appropriate column according to how you view this applicant. Overall Maturity for Age Excellent Very Good Good Poor Trustworthiness Self Discipline Teachable Attitude Emotional Stability Deals well with personal failures Resilience under difficult circumstances Ability to listen to others opinions Humility Ability to lead others effectively Overall Ability to Perform in a Work Setting

Quality of work Dependability Analytical/ Problem Solving skills Attention to detail & organisational skills Effective oral and written skills Personal Initiative Ability to work with little supervision Patience and flexibility Appropriate level of self confidence Work Ethic Overall Interpersonal Skills Pleasantness of demeanour Tactfulness Confidentiality

 

A21 - Internship Reference Forms Page  3  

For International Field applicants only: In your opinion what is the candidate’s ability to live independently in a developing country i.e. low maintenance lifestyle, ability to adapt to new situations.

In your opinion what are the applicant's greatest strengths and weaknesses in the workplace?

Thank you for completing this reference check for this applicant. We appreciate your time and integrity. This form is to be accompanied by a formal letter of reference. Signature of Reference Provider …............................................................. Date...................