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Applicant name
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Applicant position when employed
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Date employed from
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Date employed to
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Day
Day
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Month
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Year
Year
2027
2026
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2024
2023
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2021
2020
2019
2018
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2016
2015
2014
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2012
2011
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1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Your name
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Company name
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Email
Telephone
Reason for leaving
Would you employ this person again?
Yes
No
Reliability?
Excellent
Good
Fair
Poor
Attendance record?
Excellent
Good
Fair
Poor
Work Performance?
Excellent
Good
Fair
Poor
Honesty & Integrity
Excellent
Good
Fair
Poor
Attitude
Excellent
Good
Fair
Poor
Please add any comments that you feel are relevant
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I confirm that to the best of my knowledge the information provided in this form is accurate
