reference form

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Reference form

Referee Details

First Name

Last Name

Phone/Mobile

Job Title

Company

Applicant Fullname

Date Employed from

Date Employed to:

Would you re-employ this person?

Yes

SECTION 1 – HOW WOULD YOU ASSESS THE FOLLOWING?

	Excellent	Good	Average	Poor
Ability to follow care plans
Reliability, timekeeping,attendance
Character
Attitude
Ability to ensure dignity is upheld
Communication
Relationships with colleagues
Ability to work under own initiative

SECTION – 2 Please answer the following questions

Has the applicant been subject to any disciplinary action?

Yes

Are you aware of the applicants involvement in any safeguarding investigations previous or current .

Yes

Are you aware of any reasons why the applicant should not be employed to work with children or vulnerable people?

Yes

To the best of your knowledge, has the applicant been convicted or cautioned of a criminal offence?

Yes

Additional Comments

PLEASE CONFIRM:

I can confirm that all the details provided are accurate at the time that this reference was completed. I can confirm that I am authorised to provide a reference on behalf of my organisation. I understand this reference may be shown to a third party for auditing purposes and I can confirm that Maxlifecare Ltd and this organisation has consent and authorisation to disclose the contents of this reference to its end user, hirer clients. I understand that the applicant has the legal right to request a copy of their reference.

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Signature

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At MaxLife Care UK, we are committed to providing exceptional domiciliary services and training to support individuals in maintaining their independence and quality of life in the comfort of their own homes.

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Registered in England & Wales, Company Registration No: 14571187.

CQC Registration Number 1-15753419896