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Field House - New Reference Request Form

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frankmcd15x
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25 views2 pages

Field House - New Reference Request Form

Uploaded by

frankmcd15x
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Applicants Name: JEMMA MACGILLIVRAY

Position applied for: KITCHEN ASSISTANT

Please complete your details:


Name

Job Title

Name of Organisation

Contact Number

How long have you known the applicant Year(s) Month(s)

In what capacity?

Current Line Manager / Previous Line Manager / Work Colleague / Other - please state

From: To:
Applicants Position Place of Work Month & Year Month & Year

Is the applicant still in your employment? YES/NO (delete accordingly)

If NO please give reason for leaving

Character
Please give your opinion of the applicant’s character, with particular regard to:
Good Acceptable Poor

Integrity

Temperament

Initiative

Trustworthiness

Reliability

Honesty

Flexibility

Personal Skills
Please give your view of the applicant’s ability with regards to:
Good Acceptable Poor

Communication Skills

Team Working

Time Keeping
Work / Experience
Please give your opinion of the applicant’s ability with particular regards to:
Good Acceptable Poor

Relationships with work colleagues

Relationships with other professionals and Managers

Work attitude

Motivation

Working without supervision

Professional judgement

Are you aware if the applicant has been subject to any investigations or proceedings or has ever been
disqualified from the practice of a profession relating to Health or Social Care profession by any regulatory
body in the UK or any other country?

If the answer is yes to any part of this question, please give a brief outline of details:

Healthcare organisations are exempt from the Rehabilitation of Offenders Act 1974, which means you
may mention any convictions that the applicant has of which you are aware.

Please give details:

Please state how many days Parental Leave have been taken by the applicant whilst in your employment

Has there been any instance of disciplinary action taken against this person in the last 12 months?
YES/NO (delete accordingly)

If yes, please give details:

Is there currently any disciplinary action pending against the applicant? YES/NO (delete accordingly)

If Yes, please give details:

Would you reemploy this person? YES/NO (delete accordingly)

Are there any further comments that you wish to add concerning the applicants suitability for the position:

Signature

Name

Date Official Stamp

Telephone call made to confirm individual and company identity

Date: Print and Sign

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