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Referee Details

Referee Name*

Applicant Details

Name*
DD slash MM slash YYYY
DD slash MM slash YYYY
would you re-employ ?*

SECTION 1 - HOW WOULD YOU ASSESS THE FOLLOWING?

Please tick the relevant boxes Excellent, Good, Average, Poor
General Conduct*
Reliability, timekeeping,attendance*
Relationship with colleagues/nursing staff*
Relationships with patients/service users*
Ability to ensure dignity is upheld*
Communication Skills*
Relationships with patients/service users*
Ability to work under own initiative*

SECTION - 2 Please answer the following questions

Has the applicant been subject to any disciplinary action?*
Are you aware of the applicants involvement in any safeguarding investigations previous or current .*
Are you aware of any reasons why the applicant should not be employed to work with vulnerable people?*
To the best of your knowledge, has the applicant been convicted or cautioned of a criminal offence?*

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 SNS Healthcare Services 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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    5 Chorley New Road,
    Bolton,
    BL1 4QR

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    T: 0120 491 3304
    E: info@snshealthcare.co.uk
    E recruitment@snshealthcare.co.uk

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