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Reference Response
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Reference Response Form
Employment Reference Check
Please fill in and submit the form below.
Candidate Forename
Candidate Surname
Candidate NI Number
Role applied for:
Nurse
Healthcare Support Worker
Other
Date Employed From:
Date Employed To:
In what capacity do you know the candidate?
Post held by candidate
Reason for leaving
Were there any concerns with the candidate's attendance
Yes
No
Are there any live disciplinary warnings or ongoing investigations on the candidate's file/live warnings at the time of leaving?
Yes
No
Are there any concerns relating to the candidate having access to children or vulnerable adults or working in close contact with children or vulnerable adults?
Yes
No
Please provide a brief statement about the candidate's character and suitability for the role in question
I confirm that: - the information provided above is to the best of my knowledge true, fair, accurate and not misleading - if required, this reference can be shared with the named candidate
Yes
No
I confirm I am authorised to supply this reference on behalf of my organisation
Yes
No
Your Name
Organisation Name
Your Position
Your Email
If your email address does not include your organisation's name, please upload here a PDF or JPEG copy of an official company document, such as headed letter paper, business card, compliments slip or company leaflet
I allow Care For U (Leicester) Ltd. to process my personal data.
Submit Reference Response
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