Reference Check Form

Your details

First Name*
Please enter your first name.
Please enter your first name.
Last Name*
Please enter your last name.
Please enter your last name.
Email*
Please enter your email.
Please enter your email.
Phone Number*
Please enter your phone number.
Please enter your phone number.

Who are you doing a reference for?

First Name*
Please enter their first name.
Please enter their first name.
Last Name*
Please enter their last name.
Please enter their last name.

Reference

Are you a relative, friend or colleague?*
If not, what is your relationship to the applicant?
Field is required!
Field is required!
How did you initially meet them?*
Field is required!
Field is required!
When did they start and finish working for/with you?*
MM/YYYY to MM/YYYY (Limit of 200 characters)
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
What was the youngest child’s age when they started working for/with you?*
What were the ages of other children in their care?
Field is required!
Field is required!
What were their responsibilities whilst they worked for/with you?*
Field is required!
Field is required!
Did they have sole or shared care? Please describe the blend of care:*
Sole means they were responsible for looking after children by themselves. (Limit of 200 characters)
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Describe their punctuality or lack there of:*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Describe how you perceive their honesty and integrity:*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Describe their communication skills*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Describe how they respond to feedback and direction:*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Was there ever a complaint about their performance, safety or behavior? (*If so please explain)*
Field is required!
Field is required!
Describe their strengths and weaknesses*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Why did they leave your employment?*
Field is required!
Field is required!
Would you employ them again?*
Field is required!
Field is required!
Would you recommend them to work with families in private homes?*
Limit of 200 characters
Please answer the question and limit your answer to 200 characters (including spaces).
Please answer the question and limit your answer to 200 characters (including spaces).
Submit