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Reference Request Form

Hufdjknnn

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fohaezu
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28 views3 pages

Reference Request Form

Hufdjknnn

Uploaded by

fohaezu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Registered Company No.

6107910

CONFIDENTIAL REFERENCE REQUEST

UNLESS YOU INDICATE TO THE CONTRARY,


THE CONTENTS OF THIS REFERENCE MAY BE DISCUSSED WITH THE APPLICANT

CANDIDATE DETAILS

Candidate Name: Samuel Chijioke Ohaezu

Candidate DOB: 21/05/2000

Position Applied For: Healthcare Assistant

REFEREE DETAILS

Name of Referee Michael Klinn

Job Title: Manager

Organisation: The Sage

Telephone Number: 07859808712

Relationship To Candidate: Senior

EMPLOYMENT DETAILS

Please confirm the below details regarding the named applicant above:

Position held within your company: Cleaner

Dates of Employment 11/11/2022-20/01/2023

How long have you known the individual and in what


2 Months
capacity?
APPLICANT DETAILS

Why did the applicant leave your employment, if


applicable?
Standard of Performance (please circle response): Excellent / Good / Satisfactory / Poor
Additional Comments:
Honesty (please circle response): Excellent / Good / Satisfactory / Poor
Additional Comments:
Punctuality (please circle response): Excellent / Good / Satisfactory / Poor
Additional Comments:
Conduct (please circle response): Excellent / Good / Satisfactory / Poor
Additional Comments:
Relationship with others (please circle response): Excellent / Good / Satisfactory / Poor
Team Members (please circle response): Excellent / Good / Satisfactory / Poor
Managers (please circle response): Excellent / Good / Satisfactory / Poor
Additional Comments:

ADDITIONAL DETAILS

Please use this space to indicate


whether you are satisfied that the
person has the ability and is suitable to
undertake this job as indicated in the
person specification. Please comment
on the applicant’s suitability for the post
and demonstrate how they meet the
person specification commenting on the
areas of required knowledge,
experience, skills and abilities,
Has the individual been subject to
capability procedures within the last 2 Yes / No
years?
If yes, please provide details of the
concerns which gave rise to this, the
duration of the proceedings and the
outcomes.
Did/has the individual been subject to a
disciplinary procedure (e.g. formal
warning, demotion, redeployment due
Yes / No
to misconduct or dismissal) whilst in
employment with yourselves (please
circle response)?
If yes, please provide details of any
disciplinary record even if any action is
now considered expired for disciplinary
purposes. Please state if the candidate
was found guilty of dishonesty and/or
breach of trust:
Is/has the individual ever been subject
to an Employment Tribunal or Yes / No
Employment Appeal Tribunal?
If yes, please provide details (including
the nature of the candidate’s
involvement):
To your knowledge has the applicant
ever been convicted of a criminal Yes / No
offence?
If yes, please provide details:
Has the applicant been charged with a
criminal offence or are criminal charges Yes / No
against him/her pending?
If yes, please provide details:
Has the applicant been the subject of
any child/vulnerable adult protection Yes / No
concerns?
If yes, please provide details of any
enquiry:

RE-EMPLOYMENT

Are you aware of any justifiable reason


why we should not employ him/her or of
any reason why he/she should be Yes / No
considered unsuitable to work with
children?
If yes, please state your reasons:

DECLARATION

I declare to the best of my knowledge that the information provided within this reference is factually correct
NAME:
SIGNATURE:
DATE:

Company Stamp:

Please return this form to: Primary Care Recruitment Ltd, 10 Lansdowne Terrace, Gosforth, Newcastle Upon
Tyne NE3 1HN.

Office Use Only; I can now confirm that I have done the correct checks by checking the establishment
online and calling the above referee on a landline number to ensure that the referee works there.
Reference accepted by:
NAME:
Job Position:
SIGNATURE:
DATE:

0191 284 7001


[email protected]
www.primarycarerecruitment.co.u

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