SCIMITAR

SCIMITAR CARE HOTELS PLC

Serving the community since 1973

Reference Request Form (Work reference)

PRIVATE & CONFIDENTIAL

The following named person has applied for the position shown within Scimitar Care Hotels PLC.
Enclosed is a copy of the relevant job description and person specification, using these documents as a
basis we would be most grateful if you would complete this reference form and return it to us in the
stamp addressed envelope provided or digitally via the email address that this request has been sent to.

Name of applicant: Ruth Munemo

Position applied for: Care Assistant

Care Hotel: Bullsmoor Lodge

Reference Request
How long have you known
the applicant?
In what capacity have you
known the applicant?

About the applicants service with you

Position/s held:

Salary:

Period of service: From: To:

Reason for applicant leaving

your employment?
Does the applicant have any
active warnings on file in
regards to misconduct?
Would you re-employ the
applicant?

About the applicants attendance / time keeping / sickness

How would you
Excellent Good Average Substandard Poor Comments
rate the applicant’s
Attendance record:

Time keeping:

All information supplied by you will be treated in the strictest confidence and will only be used in the
applicant selection process to enable us to fill this position, however please note that under the Data
Protection Act of 1998 and Freedom of Information Act 2000 the individual concerned may request
access to any information that is held on them.
 Sickness record:

All information supplied by you will be treated in the strictest confidence and will only be used in the
applicant selection process to enable us to fill this position, however please note that under the Data
Protection Act of 1998 and Freedom of Information Act 2000 the individual concerned may request
ccess to any information that is held on them.
 Please comment on the applicants qualities in respect of the following:
Excellent Good Average Substandard Poor Comments:
Honesty,
trustworthiness and
professional
integrity:
Professional
approach to their
work:
Respect and
courteous towards
others:

Performance as part
of a team:
Ability to work on
their own and
assume
responsibility:
Compassion and
attitude to residents
/ service users:

Please give your opinion on

the applicants overall
suitability for the post, based
upon the details provided in
the job description:

Please provide any other

information which you feel
may be useful:

Your Details

Your name: Your signature:

Your position:
Date:

Your company Your Company

name: stamp:
Please include your company stamp, business card or a compliment slip.

All information supplied by you will be treated in the strictest confidence and will only be used in the
applicant selection process to enable us to fill this position, however please note that under the Data
Protection Act of 1998 and Freedom of Information Act 2000 the individual concerned may request
ccess to any information that is held on them.