Confidential Reference Request Form CRPlease enable JavaScript in your browser to complete this form.Name of candidate *In what capacity was the above person known to you? *EmployeeEmployeeFriendColleagueOtherJob title whilst in your employment? *Dates employed from dd/mm/yyyy *Dates employed to dd/mm/yyyy *The above named candidate has applied to be included on our register of carers and states that he/she was employed by you as stated above. It would be most helpful if you would provide us with a reference for this person. Please could you confirm that the above details of the applicant are correct and, in addition, comment on the following. (In order to protect the public, the post for which this application is being made is exempt from Section 4.2 of the Rehabilitation of Offenders Act 1974 (Exemption 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 would considered as "spent" in relation to this application and which you consider relevant to the applicant's suitability for employment)Professional Competency *ExcellentGoodAverageJust AcceptableNot AcceptableReliability *ExcellentGoodAverageJust AcceptableNot AcceptableTimeKeeping / Attendance *ExcellentGoodAverageJust AcceptableNot AcceptableHonesty *ExcellentGoodAverageJust AcceptableNot AcceptableAttitude *ExcellentGoodAverageJust AcceptableNot AcceptableFlexibility *ExcellentGoodAverageJust AcceptableNot AcceptableAbility to work in a team *ExcellentGoodAverageJust AcceptableNot AcceptableCommunication Skills *ExcellentGoodAverageJust AcceptableNot AcceptableWould you re-employ this person? *YesNoIf no, please explain why?Are you aware of any impediment that would restrict this person from working with children? *YesNoIf yes, please explain why?How many sick days whilst in your employment?Please put any additional comments you would like to make about this person here:Has this person ever been involved in any suspensions and/or disciplines? *Details of RefereeName *FirstLastPosition *Company *Email *Date *EmailSubmit