Reference Request Form Reference Request Form Thank you for providing your reference to Crossroads Sir Gâr. Please answer all the questions, ensure the reference is accurate, factual, and does not contain any material misstatement or omission that may lead to an unsuitable candidate being appointed to work with vulnerable adults and/or children. Your Name*Company and Position Held?Name of candidate you are providing a reference for?*How long have you known the candidate?In what capacity did you know the candidate?What date did their employment start? Date Format: DD slash MM slash YYYY What date did their employment finish? Date Format: DD slash MM slash YYYY Candidate current/previous post titlePlease comment on the candidate's skills, qualities, and abilitiesHonestyPlease select...ExcellentGoodAverageBelow AverageNot ApplicableReliabilityPlease select...ExcellentGoodAverageBelow AverageNot ApplicableTrustworthyPlease select...ExcellentGoodAverageBelow AverageNot ApplicableAbility to develop good working relationships with service users while maintaining personal boundariesPlease select...ExcellentGoodAverageBelow AverageNot ApplicableAble to work independently but within policies & proceduresPlease select...ExcellentGoodAverageBelow AverageNot ApplicableDemonstrates care & respect for vulnerable adults & childrenPlease select...ExcellentGoodAverageBelow AverageNot ApplicableGood verbal & written communication skillsPlease select...ExcellentGoodAverageBelow AverageNot ApplicableUnderstanding of confidentialityPlease select...ExcellentGoodAverageBelow AverageNot ApplicableSafeguarding & promoting welfare of vulnerable adults & childrenPlease select...ExcellentGoodAverageBelow AverageNot ApplicablePlease provide details of any disciplinary procedure the candidate has been subject to that involves the safety and welfare of vulnerable adults and/or children including any disciplinary sanction that is current or has expired.Please provide details of any allegations or concerns that have been raised about the candidate that relate to the safety and welfare of vulnerable adults and/or children or behaviour towards vulnerable adults and/or children and what the outcome was (eg. whether the allegations were investigated, the conclusion reached and how the matter was resolved.)How many days absence has the candidate had in the last year and on how many occasions have they been absent (other than disability or maternity related absences)?Number of DaysNumber of OccasionsWhy did the applicant leave your employment?If applicable, are you completely satisfied the candidate is suitable to work with vulnerable adults and/or children?YesNoNot ApplicableIf no, please provide further detailsDo you consider the candidate has the ability and is suitable for the job for which they have applied?YesNoPlease provide further details below
