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Remake Reference Form-Signed-1

The document is a Reference Request Form for Remake Care, requiring detailed evaluations of an applicant's abilities, motivation, personality, rapport, and overall performance. It includes sections for the referee to provide information on the applicant's employment dates, disciplinary actions, sickness absence, and their relationship with the applicant. The form also requests consent for disclosing the reference to the candidate and third parties, and requires the referee's signature and date.

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foodiej285
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5 views3 pages

Remake Reference Form-Signed-1

The document is a Reference Request Form for Remake Care, requiring detailed evaluations of an applicant's abilities, motivation, personality, rapport, and overall performance. It includes sections for the referee to provide information on the applicant's employment dates, disciplinary actions, sickness absence, and their relationship with the applicant. The form also requests consent for disclosing the reference to the candidate and third parties, and requires the referee's signature and date.

Uploaded by

foodiej285
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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Remake Care

1127 Rochdale Road


Blackley, Manchester
M9 7FW
[email protected]
Reference Request Form

Name of Applicant:

Position Applied for:

Please complete this reference form as comprehensively as possible.

Please print and send to the address below, or email to [email protected]

Tick the appropriate box

ABILITY
Very Good Good Average Poor Additional
comments
Knowledge/
skills in the job
description
and/or personal
specificaton

Practical ability

Understanding
of care issues
Team working
Abilty to work
unsupervised
MOTIVATION
Very Good Good Average Poor Additional
comments
Willingness to
learn
Self-
organization
skills
Contribution to
department
Punctuality
Conscientious

PERSONALITY
Very Good Good Average Poor Additional
comments
Peformance
under pressure
Interpersonal
skills

RAPPORT AND CO-OPERATION


Very Good Good Average Poor Additional
comments
Colleague
Service users/
relatives/
significant
others.

OVERALL PERFORMANCE
Very Good Good Average Poor Additional
comments
Please tick the
appropriate box.

Dates of employment (if applicable): 9th November 2023


Reason for leaving (if applicable): Still employed
Has the applicant been subjected to disciplinary action/ investigation? Yes/No
(Please highlight)
If yes, please provide details:

How many periods of sickness/absence has the applicant had within the last 12
months? 0
_____ days on
occasions.

How long have you known the applicant? Less than 2 years
Employer
What is the relationship with the applicant? Line Manager
(Please highlight)
*if highlighted other please specify: Work Colleague
Friend
Other
Are you aware of any reason(s) why the applicant should not be offered the above Yes/No
job position within Remake care Ltd?
(Please highlight)

If yes, please state the reason(s):

I hereby grant permission for the above reference to be disclosed to the candidate: Yes/No

I hereby grant permission for the above reference to be disclosed to a third party: Yes/No
Any other information relevant to this applicant:
(If necessary, please continue on another sheet)

Print Name of Referee: IFE ADO AFONNE

Signature:

Date: 25th March 2025


*Please attach proof of company contact details i.e.Business card/ Company Stamp/ Compliment Slip.

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