CHARACTER REFERENCE FORM
The applicant below would like to be accepted by Principle Support for the purpose
of being a support worker. If accepted, she/he will spend time supporting vulnerable
adults in various settings and activities. You will be contacted by our organisation to
confirm this reference.
1. Name of applicant:
Inzemam Khan
Reference Information:
2. Name of reference: Muhammad Ali khan
3. Day Time Telephone: +92 3199180584
4. Evening Time Telephone: +92 3199180584
5. Address: Nowshera Pakhtunkhwa Pakistan
I confirm that The Information Below is True and Correct
Signature of The Referee: Ali Date: 16-Oct-2025
6. How long have you known the applicant: April - 2019
7. How do you know the applicant? (Example: employer, neighbour, work colleague
etc.)
• Work Colleague
8. Please check the most appropriate box regarding applicant’s abilities:
Abilities Excellent Very Good Good Poor Don’t
Know
Communication V Good
Skills
Work Quality Excellent
Attitude Good
Reliability V Good
Maturity Good
Helpfulness Excellent
Ability to work V Good
with other
CHARACTER REFERENCE FORM
9. Please describe why you think the applicant would be suitable for the role:
The applicant would be highly suitable for a care supporter role. He consistently demonstrate
empathy, patience, and respect when supporting others, which are essential qualities in care
work. He is able to respond calmly and effectively in challenging or sensitive situations.
10. Please provide any additional comments about the applicant’s character:
He shows strong reliability, maintain professional standards, and understand the importance
of dignity, safeguarding, and confidentiality. Their ability to work as part of a team, while
also using initiative when needed, makes them a valuable and trustworthy member of any
care environment.
Interviewer Use Only:
Verified By: ____________________________ Date: _____________
Signature: ___________________________________
Comments:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________