Employment Reference Request Form | Health And Social Care Recruitment

Reference Date:

For the attention of

Re : Reference Request for

Start Date:

End Date:

The above person has applied for the post of Support Worker/HCA in our agency, Orbis Healthcare Recruitment and has named you as a referee. I would be grateful if you would express your opinion on the suitability of the applicant for the post specified, in addition to the following specific enquiries. Please be assured that your reply is confidential.

Care Cordinator

For & Behalf of Orbis Healthcare Recruitment

Professional Quality & Adequate	Score/Comments Score (1=Poor, 5=Excellent)
Appearance
Professional manner
Use of initiative
Understanding of Service Users' requirements
Attention to detail
Interest and Enthusiasm
Attitude to Service Users
Attitude to visitors
Attitude to supervisors and senior staff
Attitude to colleagues
Response to constructive advice and criticism
Oral and written reports
Powers of observation
Outstanding qualities
Time Keeping
Sickness absence

Difficulties and limitations	Yes No

Any criminal action, disciplinary action or investigations taken against the applicant, known to you:	Yes

General comments	Yes No

Would you re-employ?	Yes No

How long have you known the applicant and in what capacity? Please also specify where did you worked/supervised him with place and period worked	Yes No

Organization Full Name
Referee Name / Sign.
Date
E-mail Address
Contact Number

Organization Full Name
Signed (referee)
Date
E-mail Address
Contact Number