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On Call: 0113 294 2397 ◆ 07838 294847

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Reference Form

Reference Form

This person has given your name as a referee and I would therefore be grateful if you could complete the reference form below at your earliest convenience. May I take this opportunity to thank you in advance for your prompt response.

Form

Please leave blank:

Name of applicant:

Position Applied for:

Job title whilst employed/engaged:

Dates of employment (to-from):

Reason(s) for leaving:

Duties and responsibilities:

Strengths:

Areas for development:

Please use this tick the most relevant box on the form below to grade the applicant on the following:*

Punctuality:

Excellent

Very Good

Satisfactory

Poor

Attendance and health record:

Excellent

Very Good

Satisfactory

Poor

Time management:

Excellent

Very Good

Satisfactory

Poor

Relationship with service users/clients:

Excellent

Very Good

Satisfactory

Poor

Relationship with colleagues and management:

Excellent

Very Good

Satisfactory

Poor

Ability to work as part of a team:

Excellent

Very Good

Satisfactory

Poor

Ability to work alone:

Excellent

Very Good

Satisfactory

Poor

Following direction:

Excellent

Very Good

Satisfactory

Poor

Ability to make decisions:

Excellent

Very Good

Satisfactory

Poor

Written and verbal communication skills:

Excellent

Very Good

Satisfactory

Poor

Overall competency during assignments:

Excellent

Very Good

Satisfactory

Poor

Honesty and integrity:

Excellent

Very Good

Satisfactory

Poor

Do you have any further comments?

Are you aware of any disciplinaries or dismissals?

If yes, please give details:

Are you aware of any convictions/cautions that this applicant may have/have had (spent/unspent)?

If yes, please give details:

Are you aware of any incidents of insubordination or threatening behaviour?

If yes, please give details:

Would you re-employ?

Please give details / reasons:

Your Name:

Telephone:

Date:

Job title:

Address:

Company Name:

Thank you for taking the time to complete this form.

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MedCare HQ, Malmarc House, 116 Dewsbury Rd, Leeds, West Yorkshire. England, United Kingdom.

Email Us:

enquiries@medcarehq.com

VAT No: GB400843630

Company registration number (England & Wales): 12366877

Call Us (including out of hours):

0113 294 2397 ◆ 07838 294847

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Locations We Supply:

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Manchester, Milton Keynes, Nottingham, Peterborough, Ripon, Sheffield, Skipton, Sutton on Ashfield, Warrington

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