To be completed by the Applicant
Referee’s report for (Applicant Name):
______________________________________________________
Application for: Ansted
Social Responsibility International Award 2004
Please give your opinion of the Applicant’s
abilities, character and suitability of the applicant for the Ansted Social
Responsibility International Award 2004:
_____________________________________________________________________________________
In what way has the nominee
contributed substantively to corporate and social life? : __________________
_____________________________________________________________________________________
What are the special reasons
in your opinion, for which the nominee deserves the award? : _____________
_____________________________________________________________________________________
Referee Name:
_________________________________________________________________________
Referee Permanent Address:
______________________________________________________________
_____________________________________________________________________________________
Job Title:
______________________________________________________________________________
Highest Qualification in Education:
_________________________________________________________
Telephone : Home: __________________________________
(Work) _____________________________ Fax: __________________________________
E-mail : ________________________________________
Period of knowing the Applicant:
______________________ Can we contact directly? q
Yes q
No
Dear
Referee
Thank you for agreeing to provide a
reference on behalf of the Applicant who has presented this form to you. As part
of our selection process, we attach much importance to your views. Please be
assured that your views will remain confidential. If you prefer to provide a
reference by letter rather than use this form, please feel free to do so. As we
cannot make decisions on applications until references are available, it will be
appreciated if you can respond to this request as soon as possible. To avoid
unnecessary cost we do not acknowledge receipt of references so we thank you in
advance for your trouble. However, we will contact you again if we need any
clarification or confirmation. Please evaluate the Applicant in comparison with
his/her peer group in terms of the qualities listed below :
| QUALITY | EXCELLENT | ABOVE AVERAGE | AVERAGE | BELOW AVERAGE | POOR | NO EVIDENCE |
|
Ability to work under pressure |
||||||
| Academic Ability | ||||||
| Managerial Potential | ||||||
| Spoken English | ||||||
| Written English | ||||||
| Analytical capacity | ||||||
|
Capacity for working with others |
||||||
| Organising ability | ||||||
| Quantitative skills | ||||||
|
General intellectual ability (intelligence) |
||||||
|
Capacity to work without close guidance |
||||||
|
Emotional maturity and stability |
Referee Signature:
____________________________________Date : ____________________________
Please return this completed form to :
The Department of Ansted Social Responsibility Award,
Ansted Service Center,
P. O. Box 1067, 10840 Penang, Malaysia.