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Reference 2

The document is a reference request form for a job candidate, requiring details such as job title, organization address, and contact information for both the candidate and referee. It includes two rating stages where the referee must evaluate the candidate's clinical skills, reliability, communication skills, and other relevant attributes, as well as answer yes/no questions regarding the candidate's honesty and fitness for employment. The form also notes the legal context regarding the disclosure of any criminal convictions due to the nature of the job application.

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7 views2 pages

Reference 2

The document is a reference request form for a job candidate, requiring details such as job title, organization address, and contact information for both the candidate and referee. It includes two rating stages where the referee must evaluate the candidate's clinical skills, reliability, communication skills, and other relevant attributes, as well as answer yes/no questions regarding the candidate's honesty and fitness for employment. The form also notes the legal context regarding the disclosure of any criminal convictions due to the nature of the job application.

Uploaded by

scattyscania
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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For compliance/audit purposes, please can you confirm your job title, Work

Telephone, and your Organisation address.

Candidate Name:
Candidate Job Title:
Working From:
To:

Referee Name:
Referee Job Title:
Organisation Name:
Work Telephone:
Organisation Address:

Ratings stage 1 Please you state Excellent, Good, Acceptable,


Unacceptable. When answering the below questions.

Clinical skills demonstrated in line with the requirements of the position?


Response:

Relationships with patients, other healthcare workers and the public?


Response:

Timekeeping and management of workload?


Response:

Patient records and other records management?


Response:

Reliability?
Response:

Communication Skills?
Response:

Supervisory skills?
Response:

Organisational ability?
Response:

Sickness/absence record?
Response:

Ratings stage 2 Please type either Yes or No to the below questions.


Do you believe the named applicant to be honest, conscientious and
discreet?
Response:

Do you know of any factors concerning the named applicant which might
cause his/her fitness for employment or reasons why the named applicant
should not work in a
clinical environment?
Response:

Are you aware of any criminal conviction(s) relating to the named applicant*?
Response:

Have you had any reasons to instigate disciplinary action against the named
applicant?
Response:

Has the named applicant been or is currently the subject of any fitness to
practice
proceedings by an appropriate licencing or regulatory body in the United
Kingdom or any other country?
Response:

Do you consider the named applicant suitable for the position identified
above?
Response:

Would you re-employ the named applicant?


Response:

By returning the completed reference you are confirming that you are happy
for Staff Partners to share this reference for audit purposes.

* In order to protect the public, the post for which the application is being
made is exempt from Section 4 (2) of the Rehabilitation of Offenders Act
1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions)
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 for employment. Any such
information will be kept in strictest confidence and used only in
consideration of the suitability of this applicant for a position where such an
exemption is appropriate.

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