Character Reference Request Form
Please answer all questions honestly and accurately as possible. If you are unable to answer some sections, please write ‘N/A’.
Applicants Name
*
How long have you known this person for?
*
Please Describe how you know this person
*
How would you describe this person's work ethics?
*
How would you describe this person's character?
*
Would you recommend the applicant for the role of carer
*
Yes
No (if no, please give details below)
Please give details
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Please rate the applicant on the following competencies and add any comments in the box at the end of the section
Ability to plan, structure and prioritise own work
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to learn from situations and past experience
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to be flexible and adapt to new ways of working
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to work hard to achieve objectives and goals
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Capacity to remain calm under pressure
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Willingness to work together as a team
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to use own initiative
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Ability to communicate potential issues before they arise
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Time-keeping
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Do you have any additional comments
Your Name
Position
Date
/
Day
/
Month
Year
Date
Submit
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