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Reference Request Form VM

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mickghimself
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0% found this document useful (0 votes)
3 views2 pages

Reference Request Form VM

Uploaded by

mickghimself
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Please state what you consider to be areas that the candidate will need personal development.

The candidate would benefit from further developing their confidence in handling more complex care
situations and continuing to build their clinical knowledge and skills. Gaining additional experience in managing
challenging behaviours and enhancing leadership or decision-making abilities would also support their
professional growth.

Number of Sickness or absence record: NONE

Please advise on the following aspects of the Candidate’s Employment (where applicable) by ticking the relevant box:

Excellent Good Acceptable Poor Additional


comments
Attendance Record
Enthusiasm
Honesty & Integrity
Communication Skills
Ability to work in a team
Ability to work on own
Ability to engage with clients, service
users & their families
Flexibility
Reliability/Trustworthiness
Attitude
Managerial Skills
Timekeeping
Relationship with Colleagues

This post is exempt under Section 4(2) of the Rehabilitation of Offenders Act 1974
(Exemptions) (Amendment) Order 1986. It is not, therefore, in any way contrary to the Act to
reveal any conviction which would otherwise be considered as “spent”. Please indicate if you
know of any criminal convictions against this applicant: NO

Has a DBS Disclosure been carried out and received by your organisation? YES

If 'YES, was the outcome of the check satisfactory to you? YES/NO

We welcome any additional comments you may like to make below. Please include anything not previously
mentioned or any concerns relating to this person’s application to work as a Social Care/Community Care worker:

SIGNED: PRINT NAME: MR JOHN OBIAKO DATE: 25 MARCH 2026

POSITION: MANAGER
ORGANISATION: DIVINE MERCY HOMECARE AGENCY.
ADDRESS: AWKA, ANAMBRA STATE, NIGERIA.

Contact Number: 08033512256


Please note, for verification purposes we require references to be on your headed notepaper or endorsed with a
compliment slip or official stamp.
INDIVIDUALS HAVE A RIGHT UNDER THE DATA PROTECTION ACT 1998 TO SEE COPIES OF REFERENCES RECEIVED ABOUT THEM AND WE CANNOT
THEREFORE GUARANTEE THE COMPLETE CONFIDENTIALITY OF ANY REFERENCE RECEIVED.

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