Applicant details

Applicant name: Dr Ghazala Shaheen Post applied for: SAS/Specialty Doctor

General Medicine & Care
of the Elderly
[347-3847627-B]

Referee: Muhammad Bilal Organisation: Peshawar Institute of

Medical Sciences

Your job title: Assistant Professor

Reference form

About the applicant

How long have you known Ghazala? 03 years

In what capacity have you known Professional colleague in Medicine Department

Ghazala?

Are you, or have you ever been, No

Ghazala's direct Line Manager?

Last position held Assistant Professor Medicine

Dates Ghazala worked for your From April 2019 To: June 2022
organisation

What was Ghazala's reason for Other

leaving?

Does Ghazala currently have any No

disciplinary sanctions against them
on file?

If yes — please provide details,

including the outcome

Do you know of any cautions, No

criminal convictions, warnings or
reprimands in respect of Ghazala?
(Please note any information
disclosed will be dealt with in the
strictest confidence)

If yes — please provide details

Please provide details of Ghazala's sickness record over the last three years of employment

Number of days 7

Number of occasions 2

Comments She was very Regular Punctual and hardly took any sick leaves except
when genuinely needed as mentioned above

Reference ID: 139974202 / PV95698778 Page 1 of 3

 Would you re-employ Ghazala in a Yes
similar role / offer a further period of
study?

If no — please state why

For the criteria below, please tick one box for each row that applies:

Professional Skills / Experience

Very Good Average Below

Good Average

Knowledge

Expertise & Ability

Communication Skills

Personal Organisational Skills

Personal Qualities

Very Good Average Below

Good Average

Ability to deal sensitively and politely with public, patients and / or

colleagues

Standard and quality of work

Trustworthy

Flexibility

Seeks help appropriately

Commitment to Learning

Page 2 of 3 Reference ID: 139974202 / PV95698778

 Attitude to work and/or Training

Very Good Average Below

Good Average

Contribution to the Team / Department

Ability to meet deadlines

Ability to work under pressure

Ability to work on own initiative

Willingness to learn

Timekeeping

Reliability

Any other comments?

Declaration

Are you the person named above as Yes

referee?

Ghazala has stated that the reference covers the period from:
From To

Please confirm the period that this reference relates to:

From April 2019 To June 2022

The above information has been

provided without prejudice and is
correct to the best of my knowledge
and belief.

Data protection

This form contains personal data as defined by the Data Protection Act 2018 (as amended by the General Data
Protection Regulation 2018). This data has been requested by Southport and Ormskirk Hospital NHS Trust
exclusively for the purpose of recruitment. Southport and Ormskirk Hospital NHS Trust must protect any information
disclosed within this form and ensure that it is not passed to anyone who is not authorised to have this information.

Reference ID: 139974202 / PV95698778 Page 3 of 3