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Health Care Assistant
Support Worker
Nurse
Care Home Manager
Senior Carer
Personal Adviser
Physiotherapist
Customer Service Advisor
Name of candidate
*
0
Organisation where candidate worked
Organisation name and position held
*
0
When did they do locum or permanent work?
1
Start date
*
2
End Date
*
3
Candidate Ratings
4
Excellent / Very Good / Good / Satisfactory / Unsatisfactory
5
Ratings
*
Excellent
Very Good
Good
Satisfactory
Unsatisfactory
Diligence at work
Reliability / Time-keeping
Attendance
Trustworthiness / Honesty
Ability to work on own
Ability to work in a team
Work Performance
Interpersonal Skills
Enthusiasm
Communication Skills
Managerial Skills (where appropriate)
6
Additional Information
7
Reason for leaving
*
8
Would you re-employ this person as a staff member
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Yes
No
9
Referee details
10
Your full name
*
11
Job title
*
12
Organisation
*
13
Contact telephone number
*
14
Work email
*
15
*
I am happy to be contacted for any further clarification/information
16
Send reference