Required fields are followed by *
Name*
Phone*
Email*
Job Title*
Company*
In what capacity did you know the applicant?*
Date Employed from:*
Date Employed to:*
Would you re-employ this person?*YesNo
Please provide details:*
Ability to follow care plans* ExcellentGoodAveragePoor
Reliability, timekeeping, attendance* ExcellentGoodAveragePoor
Character* ExcellentGoodAveragePoor
Attitude* ExcellentGoodAveragePoor
Ability to ensure dignity is upheld* ExcellentGoodAveragePoor
Communication* ExcellentGoodAveragePoor
Relationships 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
Additional Comments
Check to confirm* I can confirm that all the details provided are accurate at the time that this reference was completed. I can confirm that I am authorised to provide a reference on behalf of my organisation. I understand this reference may be shown to a third party for auditing purposes and I can confirm that Elite Care Professionals and this organisation has consent and authorisation to disclose the contents of this reference to its end user, hirer clients. I understand that the applicant has the legal right to request a copy of their reference.
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Signature*
Official company stamp (optional) Accepted file types: JPG, JPEG, PNG, GIF. Max file size: 20 MB.
