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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


  • Employee's Professional Title
  • Employee's work phone number
  • Employee's home phone number
  • Employee's mobile phone number
  • Employee's Gender
  • Employee's approximate age range
  • Employee's tenure with the organisation
  • DD slash MM slash YYYY
    Please indicate what date the employee may be leaving the business
  • Is the employee expecting to hear from us?
  • Reason for referring the employee
  • Employee's reaction to their potential exit
  • List any work related concerns that may impact the employee's coaching progress.
  • This field is for validation purposes and should be left unchanged.