For the attention of: Please return at your earliest convenience to:

CHARACTER
Full name REFERENCE REQUEST Reference Facilitators
Profession Reference Co-ordinator
References2@id-medical.com
ID Medical Group, ID House, 1 Mill Square
Featherstone Road, Wolverton Mill South
Milton Keynes, MK12 5ZD
Tel: 01908 552820 – Fax: 01908810281

Applicant
Date: Thursday, 24 November 2022
Surname:
Applicant Position
Forename: Applied for:

Please kindly complete the below character reference for the above applicant.

The applicant named above has applied to ID Medical Group to be supplied as a locum for the position identified. They have provided
your name and contact details as a referee and we therefore request that you reply to the questions below, providing, in confidence, any
information you are able to or are aware of regarding their character. Please be aware the named applicant may request access to the
reference under the Freedom of Information Act 2000 and the Data Protection Act 2018 (GDPR).

Please provide the following information regarding the applicant named above:

1. How long have you known the applicant?

2. Please state the capacity you know the candidate.

3. What skills and experiences has the applicant demonstrated, that may be regarded as valuable attributes for the position
they are applying for?

By completing this reference you are providing ID Medical with consent to securely keep the reference on file and use this to support the
named applicant’s application with us.

PLEASE KINDLY COMPLETE ALL OF THE FIELDS BELOW

Referee Name Profession

Signature HANDWRITTEN Contact email

Date Signed Contact phone

ID Medical, ID House, 1 Mill Square, Wolverton Mill South, Milton Keynes, MK12 5ZD - Registered in England No. 3829536
t: +44 (0) 1908 552820 f: +44 (0) 1908 552825 w: id-medical.com