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Name*
Phone*
Email*
Job Title*
Company*
In what capacity did you know the applicant?*
Date Employed from:*
Date Employed to:* Currently Employed
Would you re-employ this person?*YesNoCurrently Employed
Please provide details:*
Ability to follow care plans* ExcellentGoodAveragePoorNot Applicable
Reliability, timekeeping, attendance* ExcellentGoodAveragePoor
Character* ExcellentGoodAveragePoor
Attitude* ExcellentGoodAveragePoor
Ability to ensure dignity is upheld* ExcellentGoodAveragePoor
Communication* ExcellentGoodAveragePoor
Relationship with colleagues* ExcellentGoodAveragePoor
Ability to work under own initiative* ExcellentGoodAveragePoor
If you select "Yes" to any of the questions below, please provide additional details in the fields that appear.
Has the applicant been subject to any disciplinary action?*YesNo
Any safeguarding investigations (past/present)?*YesNo
Any reason they shouldn't work with vulnerable people?*YesNo
Convicted or cautioned of a criminal offence?*YesNo
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