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CHARACTER REFERENCE REQUEST FORM

Please Login / Signup First

Please complete the Character form below to the best of your knowledge. Thank you for your assistance.

Name of applicant

Name and Address of referee

How long have you known Applicant?

Relationship with Applicant/ capacity known

PLEASE RATE THE APPLICANT

Attribute

Honesty

Excellent Very Good Good Average Not Satisfactory

Trustworthy

Excellent Very Good Good Average Not Satisfactory

Caring

Excellent Very Good Good Average Not Satisfactory

Reliability

Excellent Very Good Good Average Not Satisfactory

Able To Communicate

Excellent Very Good Good Average Not Satisfactory

Relationship With Others

Excellent Very Good Good Average Not Satisfactory

Conduct

Excellent Very Good Good Average Not Satisfactory

Are you aware of any health problems that may affect applicant working in a social care environment?

Yes No

If yes, please give details:

Do you know of any reason why this applicant should not engage in a social care setting?

Yes No

If yes please give details:

In your opinion, would the applicant make a good health care worker?

Yes No

Comments:

Please comment on any other information/ observations you consider relevant:

Name

Job Title

Contact No.

Signature

Date

(Please Note that this reference will not be considered valid, unless signed and dated.

Please Login / Signup First

Please complete the Character form below to the best of your knowledge. Thank you for your assistance.

Name of applicant

Name and Address of referee

How long have you known Applicant?

Relationship with Applicant/ capacity known

PLEASE RATE THE APPLICANT

Attribute

Honesty

Excellent Very Good Good Average Not Satisfactory

Trustworthy

Excellent Very Good Good Average Not Satisfactory

Caring

Excellent Very Good Good Average Not Satisfactory

Reliability

Excellent Very Good Good Average Not Satisfactory

Able To Communicate

Excellent Very Good Good Average Not Satisfactory

Relationship With Others

Excellent Very Good Good Average Not Satisfactory

Conduct

Excellent Very Good Good Average Not Satisfactory

Are you aware of any health problems that may affect applicant working in a social care environment?

Yes No

If yes, please give details:

Do you know of any reason why this applicant should not engage in a social care setting?

Yes No

If yes please give details:

In your opinion, would the applicant make a good health care worker?

Yes No

Comments:

Please comment on any other information/ observations you consider relevant:

Name

Job Title

Contact No.

Signature

Date

(Please Note that this reference will not be considered valid, unless signed and dated.

Profad Derby

Profad Rushden

Profad Southwark

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