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Data Protection Policy
Reference Form
Name of Referee:
*
Name of Employee:
Email
Referee Contact Number:
Name of Company:
Date Employee Started:
Date Format: DD slash MM slash YYYY
Date Employee Ended:
Date Format: DD slash MM slash YYYY
What is the employee's role or job title during this period?
Sickness/Absence: Number of Days off pa:
Reason for leaving?
SECTION 1 - HOW WOULD YOU ASSESS THE FOLLOWING?
Please tick the relevant boxes Excellent, Good, Average, Poor
Character
*
Excellent
Good
Average
Poor
Honesty
*
Excellent
Good
Average
Poor
Reliability,
*
Excellent
Good
Average
Poor
Timekeeping,attendance
*
Excellent
Good
Average
Poor
Attitude
*
Excellent
Good
Average
Poor
Ability to ensure dignity is upheld
*
Excellent
Good
Average
Poor
Communication
*
Excellent
Good
Average
Poor
Relationships with colleagues
*
Excellent
Good
Average
Poor
Ability to work under own initiative
*
Excellent
Good
Average
Poor
Working to deadlines
*
Excellent
Good
Average
Poor
Working under pressure
*
Excellent
Good
Average
Poor
Adapting to new situations
*
Excellent
Good
Average
Poor
Self-motivation
*
Excellent
Good
Average
Poor
Willingness to accept responsibility
*
Excellent
Good
Average
Poor
Ability to work unsupervised
*
Excellent
Good
Average
Poor
SECTION - 2 Please answer the following questions
Please tick the relevant boxes Excellent, Good, Average, Poor
Has the applicant been subject to any disciplinary action?
*
Yes
No
Please provide details:
Are you aware of the applicants involvement in any safeguarding investigations previous or current .
*
Yes
No
Please provide details:
Are you aware of any reasons why the applicant should not be employed to work with children or vulnerable people?
*
Yes
No
Please provide details:
To the best of your knowledge, has the applicant been convicted or cautioned of a criminal offence?
*
Yes
No
Please provide details:
Would you re-employ this person?
*
Yes
No
If no, please provide details:
Additional Comments
Please note that it is our policy to verbally confirm all written references
In line with Data Protection Act (UK), Commit2Care operate an open reference policy and candidates may request information provided to a organisation and therefore may request to view their reference.
Name
First
Last
Position
Name of Organisation
Contact Number
Signature
*
Date
Date Format: DD slash MM slash YYYY
Official company stamp.
Drop files here or
Accepted file types: jpg, gif, png, pdf.
If you are not using an official company email please upload a picture of your company stamp / business card/letterhead/compliment slip.