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Home
Commercial Cleaning
Office Cleaning
School & Nursery cleaning
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End of Tenancy Cleaning
Relief Cleaning Cover
Domestic Cleaning
About Us
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Contact Us
Reference Request Form
Name of Applicant:
Post Applied for:
Please give details of the applicant’s employment:
Job Title:
Date of Employment from:
Date of Employment to:
Reason for leaving:
Please give your assessment of the following areas of the applicant’s work:
Quality of care
Excellent
Good
Satisfactory
Unsatisfactory
Interpersonal/Communication skills
Excellent
Good
Satisfactory
Unsatisfactory
Working on own initiative
Excellent
Good
Satisfactory
Unsatisfactory
Planning and prioritising workload
Excellent
Good
Satisfactory
Unsatisfactory
Commitment to patients/residents
Excellent
Good
Satisfactory
Unsatisfactory
Working under pressure
Excellent
Good
Satisfactory
Unsatisfactory
Working as part of a team
Excellent
Good
Satisfactory
Unsatisfactory
Enthusiasm to learn and develop
Excellent
Good
Satisfactory
Unsatisfactory
If you have assessed any area as being satisfactory or unsatisfactory, please outline your reasons for doing so:
Sickness/Absences Please detail the applicant’s absences from the last 2 years:
Dates: (from – to)
Reason:
In your opinion is the applicant capable of performing the duties of this position?
yes
no
If not, please confirm the reason:
Have you or your colleagues ever had any cause for concern over the applicant’s behaviour, judgement, honesty or trustworthiness?
yes
no
If not, please confirm the reason: (copy)
Do you know of any previous or pending criminal convictions or current police investigations that this person may have?
yes
no
If yes, what was the nature of the offence/allegation?
Please provide details of any disciplinary action:
Did the applicant complete a satisfactory probationary period?
yes
no
If No, please give details
Are any disciplinary warnings recorded in respect of the applicant?
yes
no
If Yes, state reasons for warning(s) and when given.
Is any disciplinary action pending against the applicant?
yes
no
If Yes, please give details
Or, if the person has left your employment, was any disciplinary action pending against them at the time they left?
yes
no
If Yes, please give details
Are any proceedings pending before an Employment Tribunal or other court in respect of the applicant?
yes
no
If Yes, please give details
Would you re-employ this person?
yes
no
If not please confirm the reason:
If you have any additional comments to make, please do so below:
Signed:
Print name:
Job title:
Relationship to applicant:
Date:
Telephone No:
Company stamp:
E-mail:
Responses via email must be from a business address. Please note that, if requested under GDPR, the subject of the reference does have a right to a copy of the reference provided.
Email
Submit
