Reference Request Form

Reference Request Form
Our candidate has applied for the role of Care Worker with us and has supplied your details in support of their application. The role that has been applied for requires Care Workers to work in peoples' own homes and they are required to work with the most vulnerable people in our communities providing care and support services.
Can we kindly please ask you to complete the attached reference request as soon as possible? No employees are permitted to work without satisfactory references amongst other checks and your attention to this matter would be greatly appreciated.
Candidate Name - The person you are providing a reference for*

First NameLast Name
In what capacity do you know the candidate? *
What role did the candidate uphold?*
Start date of employment*

MonthDayYear
Date
Is employment ongoing?*

YesNo
End date of employment - If applicable

MonthDayYear
Date
Reason for leaving?*
Would you re-employ this person? If not please give reasons
What responsibilities did the candidate have?
Has this person been subject to disciplinary procedures? If yes, please explain
Are you related to the applicant?*

YesNo
Did the candidate complete the Care Certificate whilst working with you?*

YesNoNot applicable (previous employment outside of social care)
If yes, when did they complete this?

MonthDayYear
Date

How would you rate the following attributes?*

Is there anything you would like to add in support of their application?
Your Name*

First NameLast Name
Your Job Title*
Your Company Name*
Your Email Address*
example@example.com
Your Phone Number
Please enter a valid phone number.
Signature*

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Date*

MonthDayYear
Date
Upload - (Company Stamp / Business Card / Letterhead / Any other documents)

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