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About Us
Assessments
Therapies
Awards
Gallery
Testimonials
Contact

Reference Form

Reference form

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Step 1
Step 2
Step 3

Referee name

Position of referee

Contact telephone number

Referee organisation

Referee email

Candidate name

Please state how long you've known the candidate

Position held

Employed from

Employed to

Reasons for leaving

Attendance

Punctuality

Reliability

Aptitude to work

Integrity

Enthusiasm for job

Report writing

Quality of work

Clinical ability

Communication skills

Client interaction

Colleague interaction

Legislation knowledge

If you have ticked sufficient or poor for any of the above please provide us with further explanatory information

Do you consider the candidate to need Clinical or Behavioural Development?

Yes

No

If yes, please give details

Would you re-employ / work again with this person?

Yes

No

If no, please give reasons

This post involves substantial access to children. As an organisation committed to the welfare and protection of children, we wish to know if you are aware of any reason why this person might not be suitable to work with children and young people.

Yes

No

If yes, please provide more information

Are you aware of any previous substantiated allegations, sanctions and/or disciplinary action taken against this person where there were concerns relating to children’s safety or protection?

Yes

No

If yes, please provide more information

Are you aware of any current or ongoing allegations or investigations, or of any disciplinary sanctions that remain against this person? This may or may not be related to children’s safety and protection.

Yes

No

If yes, please provide more information

Are you aware of any reason why this individual should not be working in a position of trust?

Yes

No

If yes, please provide more information

To the best of your knowledge, has this individual demonstrated appropriate professional judgement and conduct when working with others?

Yes

No

If no, please provide more information

I confirm that the information provided is accurate to the best of my knowledge and that I have disclosed any relevant safeguarding concerns

Thank you for taking the time to complete our reference form. If you have any further comments that may be helpful in our consideration of this applicant, please feel free to use the space below.

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Date / Time

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Email

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If you have any questions, please don’t hesitate to get in touch.

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