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Reference Request in Confidence

Name of Referee

Name Of Candidate:

Address

Postcode

How long have you known the Candidate?

In what capacity do you know the candidate?

e.g. manager, colleague, personal capacity

Your Job Title

Their Job Title

Their Starting Date

Their Leaving Date

Salary

Additional Benefits

Reason for Leaving

Subject to a suitable vacancy, would you re-employ the applicant?

Sick absence during the last two years - Number of days within the last 24 months

Sick absence - Number of occasions within the last 24 months

If possible, please state nature of illness

Has the applicant been subject to any formal disciplinary action within the last 12 months?

Do you know of anything which would make him / her unsuitable for this appointment?

If yes to either of the above please state why

Ability to use initiative

Please select the relevant behaviour

Reliability

Please select the relevant behaviour

Quality of Performance

Please select the relevant behaviour

Punctuality

Please select the relevant behaviour

Honesty

Please select the relevant behaviour

Attitude towards work

Please select the relevant behaviour

If any of the above are rated poor, please explain why

As an employer within the social care sector we are required to make sure that only people who have the appropriate knowledge, skills and values and are suitable to provide social work or social care services, enter our employment. Is your organisation aware if the applicant above has any outstanding conduct, disciplinary, capability matters on file or whether they are currently the subject of any investigations or other proceedings that could now or in the future call into question their fitness to practise within the social care sector?

If yes please provide details

Is there any further information you would like to add which would help in assessing the suitability of this person to work within the Simon Community?

Date

Contact phone number

reCAPTCHA

PLEASE NOTE THE CONTENTS OF THIS REFERENCE MAY NEED TO BE DISCUSSED WITH THE APPLICANT AND MAY BE SUBJECT TO CHALLENGE.