Online Reference Submission We would be very grateful if you would complete the below reference or provide your own with suitable details. Please give your assessment of the applicant’s suitability for this kind of work, by answering the questions below. Your reply will be appreciated and treated in the strictest confidence. Thank you in anticipation of your co-operation.Reference completed for:please enter the name of the applicant you are completing the reference for. Role to which applied:Healthcare AssistantSupport WorkerHome Care Worker / Domiciliary Care WorkerReference Type:*EmploymentCharacterDate reference completed:* DD slash MM slash YYYY Your DetailsName* First Last Current Job Title:*Professional membership PIN:only if applicable example NMC, NISCC etc..Organisation or personal address:* Street Address Address Line 2 City County Postcode Contact Number:*Email:* ensure your email is entered correctly - you will receive a completed copy of this form.Character Reference1. How long have you known the applicant for?*2. In what capacity do you know the applicant?*3. Would you describe the applicant as dependable? Yes No I can't answer 4. How would you rate their general conduct? Excellent Very Good OK Poor I can't answer 5. As a character reference please describe your relationship to the candidate, their strengths and weaknesses and in your opinion what makes them suitable for the role they have applied for*In order to protect the public, the post for which application is being made exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the exemptions order 1975. It is not, therefore, in any way contrary to the Act to reveal any information you have concerning convictions which would otherwise be considered ‘spend’ to the applicant’s suitability for employment. Any such information will be kept in strict confidence and used only in consideration of the suitability of this applicant for a position where such exemption is appropriate.Should you have any questions or queries contact our office using the options below. Address: Lydian Care, 33 Main Street, Newcastle, Co. Down, BT33 0AD Tel: 028437 25385 Email: recruitment@lydiancare.com Signature*Please either draw using the pen with your mouse or if you are completing on your mobile or handheld device use your finger or stylus to sign your name.If you have a scanned signature or company letter head please upload below: Drop files here or Select files Max. file size: 496 MB. Employment ReferenceIf it is company policy to only provide dates of employment please complete the dates, whether you would re-employ this person and if there are/were any live warnings or disciplinary issues pending as seeking this information is an RQIA requirement.Start Date:* DD slash MM slash YYYY End Date: DD slash MM slash YYYY If still actively working leave blank.Role to which they were employed:*What role or job title did they have during their employment with you.1. Would you re-employ this person?* Yes No It is company policy to not re-employ N/A 2. Were/Are there any live warnings or disciplinary issues pending when this individual left your employment?* Yes No Please state the details:3. Attendance Excellent Very Good OK Poor N/A 4. Timekeeping Excellent Very Good OK Poor N/A 5. Trustworthiness Excellent Very Good OK Poor N/A 6. General Conduct Excellent Very Good OK Poor N/A 7. Interaction with service users and or work colleagues Excellent Very Good OK Poor N/A 8. Ability to use Initiative Excellent Very Good OK Poor N/A 9. Ability to work without supervision Excellent Very Good OK Poor N/A 10. Please provide any further information applicable to this candidate or expand on the headings above if you wish in the text box belowIn order to protect the public, the post for which application is being made exempt from Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the exemptions order 1975. It is not, therefore, in any way contrary to the Act to reveal any information you have concerning convictions which would otherwise be considered ‘spend’ to the applicant’s suitability for employment. Any such information will be kept in strict confidence and used only in consideration of the suitability of this applicant for a position where such exemption is appropriate.Should you have any questions or queries contact our office using the options below. Address: Lydian Care, 33 Main Street, Newcastle, Co. Down, BT33 0AD Tel: 028437 25385 Email: recruitment@lydiancare.com Signature*Please either draw using the pen with your mouse or if you are completing on your mobile or handheld device use your finger or stylus to sign your name.If you have a scanned signature or company letter head please upload below: Drop files here or Select files Max. file size: 496 MB.
