Employment Reference Form

Reference Check
Are you in anyway related to the candidate *
Capacity in which employed *
Please tick appropriate boxes
Was his/her service to all respects satisfactory?
Was disciplinary action taken?
Professional Competence *
Organisation Skills *
Acceptance of Responsibility *
Work/Caseload Management *
Time Management *
Reaction to busy environment *
Punctuality *
Commitment and Motivation *
Leadership Skills *
Confidentiality *
Quality Conscious *
Interpersonal Communications with service user / family / customer / visitors *
Interpersonal Communications with fellow students / colleagues *
Interpersonal Communications with Supervisors / Managers *
Was his/her attendance satisfactory? *
This should be used for any areas marked unsatisfactory.
Were there any issues in relation to sick leave? *
Would you employ this person?
Would you recommend this person as someone suitable for this particular post in the health service? *