Recruitment

REFERENCE REQUEST FOR (required)

Your Name & Position (required)

Company Name & Address where worked with candidate

Relationship with candidate

1. Employment Details

Date Employed From (required)

Date Employed To (required)

Candidates Job Title(required)

Reason For Leaving (required)

Re-employ? (required)
YesNo

Comments/further information

2. Please Comment On The Following

General Conduct (required)
ExcellentGoodSatisfactoryPoor
Timekeeping (required)
ExcellentGoodSatisfactoryPoor
Communication Skills (required)
ExcellentGoodSatisfactoryPoor
Relationship with colleagues/nursing staff (required)
ExcellentGoodSatisfactoryPoor
Relationship with patients/service users (required)
ExcellentGoodSatisfactoryPoor
Has the candidates honesty and integrity ever been brought into question that you are aware of? (Please comment) (required)

Level of performance (required)
ExcellentGoodSatisfactoryPoor
Do you consider the candidate to need Clinical or Behavioural Development? (required)

Are you aware of any suspicious proceedings, Policy investigations or disciplinary action? (required)

Additional comments. If you have ticked satisfactory or poor for any of the above please provide us with further explanatory information (required)

I declare that to the best of my knowledge the information I have given in this reference is correct and complete (required)
I Agree
E-mail (required)

Phone Number (required)

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