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    MEDACS Reference

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    jahangirealam
    This document is a reference request form for Dr. Jahangir Alam from Medacs Healthcare. The form requests information about Dr. Alam's employment dates, grade/skill level, clinical skills, relationships with patients/colleagues, timekeeping, record management, reliability, communication skills, supervisory skills, organizational ability, and sickness record. The referee is asked to rate these areas as poor, satisfactory, good, very good or excellent. Additional comments are requested to support these ratings. The form also asks how long Dr. Alam worked under the referee, their responsibilities, and any factors that could impact fitness for employment. The referee is asked to provide their contact information and signature to confirm the reference.

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    © All Rights Reserved
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    MEDACS Reference

    Uploaded by

    jahangirealam
    534 views3 pages
    This document is a reference request form for Dr. Jahangir Alam from Medacs Healthcare. The form requests information about Dr. Alam's employment dates, grade/skill level, clinical skills, relationships with patients/colleagues, timekeeping, record management, reliability, communication skills, supervisory skills, organizational ability, and sickness record. The referee is asked to rate these areas as poor, satisfactory, good, very good or excellent. Additional comments are requested to support these ratings. The form also asks how long Dr. Alam worked under the referee, their responsibilities, and any factors that could impact fitness for employment. The referee is asked to provide their contact information and signature to confirm the reference.

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    ref

    Original Title

    _MEDACS Reference

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    This document is a reference request form for Dr. Jahangir Alam from Medacs Healthcare. The form requests information about Dr. Alam's employment dates, grade/skill level, clinical skills, relationships with patients/colleagues, timekeeping, record management, reliability, communication skills, supervisory skills, organizational ability, and sickness record. The referee is asked to rate these areas as poor, satisfactory, good, very good or excellent. Additional comments are requested to support these ratings. The form also asks how long Dr. Alam worked under the referee, their responsibilities, and any factors that could impact fitness for employment. The referee is asked to provide their contact information and signature to confirm the reference.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    534 views3 pages

    MEDACS Reference

    Uploaded by

    jahangirealam
    This document is a reference request form for Dr. Jahangir Alam from Medacs Healthcare. The form requests information about Dr. Alam's employment dates, grade/skill level, clinical skills, relationships with patients/colleagues, timekeeping, record management, reliability, communication skills, supervisory skills, organizational ability, and sickness record. The referee is asked to rate these areas as poor, satisfactory, good, very good or excellent. Additional comments are requested to support these ratings. The form also asks how long Dr. Alam worked under the referee, their responsibilities, and any factors that could impact fitness for employment. The referee is asked to provide their contact information and signature to confirm the reference.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
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    This document content is a reference request form that is being sent to a referee to obtain information about a job applicant's suitability for a clinical role in the UK.

    The referee is being asked to rate the applicant's clinical skills, relationships with others, timekeeping, record keeping, reliability, communication skills, organizational ability, and honesty on a scale from poor to excellent. The referee is also asked if they know of any reasons the applicant should not work in a clinical environment.

    The reference form must be physically signed and returned, either by scanning and emailing or faxing. The referee should also provide a company stamp or signed compliment slip to validate the reference. Alternatively, the reference could be printed on official letterhead.

    Reference Request

    *CONSULTANT (REFEREE) NAME AND ADDRESS DETAILS HERE*

    Date

    Dear Doctor,

    Reference Request for: Dr Jahangir Alam

    The Doctor mentioned below has registered with Medacs Healthcare to work in the UK and has quoted you
    as a referee.

    We would be grateful if you would reply to the following questions regarding this applicant and provide in
    confidence any information which you are able to comment on regarding his/her character and suitability to
    perform the role and associated duties of the position applied for.

    Applicant name

    Organisation
    Practice/Hospital where the Worker was/is employed
    Dates of employment
    (DD MMM YYYY – DD MMM YYYY)
    Grade & Skill
    Grade & Skill covered in above position
    commentUnable to

    Satisfactory

    Very Good
    * Please ü as appropriate

    Excellent
    Good
    Poor

    (Please provide additional comments in support of the statements


    made in the space provided on the next page)

    Clinical skills demonstrated in line with the requirements of the


    position
    Relationships with patients, other healthcare workers and the public
    Timekeeping and management of workload
    Patient records and other record management
    Reliability
    Communication skills
    Supervisory skills
    Organisational ability
    Sickness/Absence record
    How would you rate the applicant’s honesty and discretion

    * Mandatory Information – Please ensure all asterisked items are completed


    Medacs Healthcare
    Reference Request

    Additional comments in support of the statements made

    How long did the named applicant work for/with you or under your supervision and in what capacity?
    i.e. clinical position/grade and specialty

    *Main details and responsibilities: (please use the additional information section if required)

    Do you know of any factors concerning the named applicant which might cause his/her fitness for
    employment or reasons why the named applicant should not work in a clinical environment?
    If so please provide details below.

    Please provide any further information relevant to the supply of the candidate as a Locum,
    e.g. which grade you consider the applicant best suited for.

    * Mandatory Information – Please ensure all asterisked items are completed


    Medacs Healthcare
    Reference Request

    Reference request completed for Medacs Healthcare by


    *Referee Job Title
    Referee Name
    Medacs Healthcare is unable to *Date
    *Signature accept unsigned references,
    please sign before returning
    *Tel. No.
    Email Address
    To confirm this reference as valid, please ensure the form is physically signed and
    *Proof of returned, either by scanning and emailing or faxing. Please also provide a company
    Organisation stamp or counter-signed compliment slip; the references could alternatively be printed
    on headed paper.

    Additional
    Information

    Please scan & email back to [email protected]

    To confirm this reference as valid, please ensure the form is physically signed and returned,
    either by scanning and emailing or faxing. Please also provide a company stamp or counter-
    signed compliment slip; the references could alternatively be printed on headed paper.

    Medacs Healthcare

    Email: [email protected]

    Tel: 0044 (0)203 096 4590

    * Mandatory Information – Please ensure all asterisked items are completed


    Medacs Healthcare

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