1 Bretton Street

Dewsbury
WF12 9BB
Tel: 01924 439803
Email: info@paradiseschool.org.uk

Name of Applicant : Maymounah Ali

Post applied for: Primary Teacher
Please answer the following as fully as possible

How long have you known the applicant?

In what capacity have you known the

applicant? (Friend, employee, colleague)
Date of employment if applicable: From: To:

Position held

Roles and responsibilities

In your experience has the applicant the ability Yes No

to maintain confidentiality?
If NO please give evidence

Is there any reason to your knowledge why this Yes No

applicant should not work with young children?
If you have answered yes please give reasons

Are you aware of any allegations or concerns

that have been raised about the candidate that
Yes No
relate to the safety and welfare of children or
behaviour towards children?
If YES, please provide any details you are aware
of, including, if possible, details of any action
that was taken with regard to these
allegations/concerns
How many days sickness / absence did this Days: Occasions:
individual have in the last 12 months of
employment and on how many occasions?
Has this individual ever been subject to an
investigation / disciplinary procedure during Yes No
their employment with you?
If YES please indicate reasons and level of
disciplinary / capability action taken

Would you consider this individual for re- Yes No

employment?

If NO please give your reasons

1 Bretton Street
Dewsbury
WF12 9BB
Tel: 01924 439803
Email: info@paradiseschool.org.uk
Please rate the applicant on the Excellent Good Average Poor Not
following: Applicable

Understanding of children’s needs

Punctuality
Team Work
Working Unsupervised
Commitment
Ability to meet deadlines
Communication skills
Customer service
Motivation
Honesty/Trustworthy
Reliability

Is there anything not already covered that you feel

should be mentioned?

Please comment on the applicant’s suitability for the post:

Declaration

I confirm that all the information supplied is true and correct record of the above named individuals
performance.
I do not wish this information to be disclosed to the candidate
I have no objections to this information being disclosed to the candidate

Signature

Date

Thank you for taking the time to complete this form. Please return it to Paradise Primary School as soon as
possible either by post or email.