Confidential Personal Reference Request FormPlease enable JavaScript in your browser to complete this form.Branch *BedfordBedfordBrightonColchesterLive inLondonNorwichPeterboroughSection *StaffingCare at HomeSpecialist and Complex CareName of person completing *FirstLastEmail address of referree *Name of Agency Worker *The above named candidate has applied to be included on our register of carers and states that they know you. It would be most helpful if you would provide us with a reference for this person and return this questionnaire to us as soon as possible. Please could you confirm the above details of the applicant are correct and, in addition comment of the following. (In order to protect the public, the post for which his application is being made is exempt from Section 4.2 of the Rehabilitation of Offenders Act 1974 (Exempt Order 1975). It is not therefore in any way contrary to the Act to reveal any information you may have concerning convictions which would otherwise be considered as “spent” in relation to this application and which you consider relevant to the applicant's suitability to employment)Dates known - FromDates known - toReliabilityExcellentGoodAverageJust AcceptableNot AcceptableTime KeepingExcellentGoodAverageJust AcceptableNot AcceptableHonestyExcellentGoodAverageJust AcceptableNot AcceptableAttitudeExcellentGoodAverageJust AcceptableNot AcceptableAre you aware of any impediment that would restrict this person from working with children?In what capacity was the above person known to you?Date MessageSubmit