Outplacement Referral Form

The information you provide below is strictly for the purposes of enabling CDL to assign to your employee the ‘best fit’
coach from within our outplacement coaching team. At all times strict confidentiality is maintained and individual privacy is respected.

Company Details
Company Name*
Referring Manager's Name
First Last
Referring Manager's Email Address
Referring Manager's Title
Billing Contact*
Billing Email*
Billing Address 1*
Billing Address 2
Purchase Order No.
EMPLOYEE BEING REFERRED FOR COACHING
Select Programme/Workshop*
Employee's Name*
First Last
Employee's Title*

Employee's Professional Title
Work Phone
Employee's work phone number
Home Phone
Employee's home phone number
Mobile Phone
Employee's mobile phone number
Employee's Email Address*
Country*
City/Town*
Gender*
Employee's Gender
Approx Age
Employee's approximate age range
Tenure with Organisation*

Employee's tenure with the organisation
Expected Departure Date
DD slash MM slash YYYY

Please indicate what date the employee may be leaving the business
Is the Employee Expecting a Call?*
Is the employee expecting to hear from us?
Reason for Referral
Reason for referring the employee
Employee's Reaction
Employee's reaction to their potential exit
Are there any other factors we should be aware of?
List any work related concerns that may impact the employee's coaching progress.
Comments
This field is for validation purposes and should be left unchanged.

Outplacement Referral Form

Company Details

EMPLOYEE BEING REFERRED FOR COACHING