Reference Request Form

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About us
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Welcome to Mated Care

the leading nursing agency in Shrewsbury!

Welcome to our online reference form for previous employers. Please provide your honest feedback on the employee’s performance. If you encounter any issues, feel free to contact us at info@matedcare.uk. Thank you for your time.

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PROFILE

Applicant Name *

First

Last

Date of birth *

EMPLOYMENT HISTORY

Layout

Job title *

Start date *

Leaving date *

In what capacity do you know the applicant? *

If "Other", please describe the circumstances *

SKILLS

Referring to the job description, please describe the applicant’s ability to undertake their role

Please inform us of any disciplinary actions that might have been taken against the applicant:

Would you re-employ the applicant?

If NO, please indicate why *

To your knowledge, has the applicant ever been convicted of a criminal offence (subject to Rehabilitation of Offenders Act 1974 Provisions)? *

If YES, please give details: *

Please select all characteristics that you believe describe the applicant.

Leader
Team Player
Reserved
Outspoken
Judgmental
Arrogant
Gruff
Kind
Gentle
Nervous
Confident
Happy
Moody
Unhappy
Aggressive
Opinionated
Stubborn
Follower
Shy
Quiet
Considerate
Empathetic
Tactful
Cooperative

Do you have any other information regarding this application, which you believe, should be known to us as prospective employers?

DETAILS OF REFEREE:

Reference Name *

First

Last

Contact

Reference Email *

Position *

Date

Signature *

Reference Phone *

Company Name *

Company Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you happy for us to contact you about the information you have provided? *

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Email *

Location

33 Dymond Drive, Shrewsbury, Shropshire, SY2 6FY, UK

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Welcome to Mated Care

the leading nursing agency in Shrewsbury!

PROFILE

EMPLOYMENT HISTORY

SKILLS

DETAILS OF REFEREE:

Phone

03330 501 559

Email

info@matedcare.uk

Location

33 Dymond Drive, Shrewsbury, Shropshire, SY2 6FY, UK