Reference Form

You have been asked to provide a reference for the following candidate:

Candidate Details

Candidate Name:

Position Applied for:

Date Requested:

01-Jan-1970

Agency Details

Agency Name:

Requested by:

Email:

Please complete all sections

If you need assistance with any aspect of the reference please contact the agency shown above. Or in case of technical difficulties please contact HB Compliance by email at support@hbcompliance.co.uk or at the number at the top of this page.

If you are unable to provide a reference please scroll down to the bottom of the page and complete the section at the end.

* - Required Fields

Referee Details

Referee Name: *

Organisation: *

Position: *

Your Email Address: *

General

Date candidate was employed by you: * From (Month/Year): To (Month/Year):

Reason for leaving employment, if applicable? *

No of days sick leave in the last 2 years of employment, if applicable? *

Grade/level in last post held by candidate with you? *

Did you supervise this candidate? If not what was your working relationship with the candidate? *

Would you employ the candidate again? If the answer is No, please clarify why? *

Are you aware of any physical or mental illnesses that may affect performance? If the answer is Yes, please give details. *

Are you aware of any criminal convictions the candidate has? If the answer is Yes, please give details. *

Assessment

	Below Average	Average	Good	Very Good	Excellent	Not Applicable
Attendence *
Timekeeping *
Reliability *
Ability to work on own initiative *
Ability to work in a Team *
Professional ability *
Relationship with:
Patients *
Staff *
Management *

Clinical Skills

Were clinical skills demonstrated in line with the requirements of the position? *
Yes
No
Not Applicable

If you have any comments in relation to this please include them in 'Any Other Comments' below

Any other comments:

Declining to provide a reference

If you are unable to provide a reference you may use this section to indicate that to the agency. It would be helpful if you were to provide a brief note on the reason you are unable to provide a reference. However providing this information is optional.

To use this section enter an optional response in the box and click the button.

Mission Statement

HB Group is an established provider of compliance solutions to the healthcare recruitment market. Our key aim is to ensure that by working with key stakeholders we can meet all your compliance requirements under one brand

Address

Abbey Mill Business Centre, 12 Seedhill Road, PA1 1JS

0141 889 5522

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