Scribd
Upload
69 views4 pages

Please Ensure That All Sections Have Been Completed.: Registered Nurse

This document is a reference request form for a registered nurse applicant. It contains 4 sections: contact information for the referee (Section A), employment details and reason for leaving (Section B), assessment of competencies (Section C), and an area for comments on the applicant's character and strengths/weaknesses (Section D). The form requests the referee provide information such as dates of employment, sickness absence, re-employment recommendation, competency ratings, and comments on personality traits to aid in evaluating the applicant for the nursing position.

Uploaded by

Matthew Dalisay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
69 views4 pages

Please Ensure That All Sections Have Been Completed.: Registered Nurse

This document is a reference request form for a registered nurse applicant. It contains 4 sections: contact information for the referee (Section A), employment details and reason for leaving (Section B), assessment of competencies (Section C), and an area for comments on the applicant's character and strengths/weaknesses (Section D). The form requests the referee provide information such as dates of employment, sickness absence, re-employment recommendation, competency ratings, and comments on personality traits to aid in evaluating the applicant for the nursing position.

Uploaded by

Matthew Dalisay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Reference request

Requested by:

Post applied for: Registered Nurse

Please ensure that all sections have been completed.

Name of the applicant:

SECTION A

Referee name:

Position:

Company:

Contact details Email address: Telephone number:

SECTION B

1
Reference request

Position of applicant (job title):

Dates of employment From: To: Salary:

Sickness absence during employment - If employed for Number of occasions:


more than 3 years please only include sickness absence for
the last 3 years - (number of days):

Reason for leaving:

Yes
Would you re-employ?
No

If No please state why:

Are you aware of any current ongoing informal or Yes


formal investigations relating to this applicant,
whether internally to your organisation or externally? No

If Yes please specify the nature of the investigations:

SECTION C

2
Reference request

Very Good Comments:


Where relevant please indicate your assessment of the following competencies by placing a tick or a Y in the
appropriateQuality assessment is below Good
of work
box. If the average, please provide a supporting comment.
Average
Below average

Very Good Comments:


Good
Attendance/punctuality/reliability
Average
Below average

Very Good Comments:


Good
Team Work
Average
Below average

Very Good Comments:


Good
Planning and organising
Average
Below average

Very Good Comments:


Ability to work without Good
supervision Average
Below average

Very Good Comments:


Ability to work under Good
pressure/meet deadlines Average
Below average

Very Good Comments:


Good
Communication skills
Average
Below average

Very Good Comments:


Good
Customer care/service
Average
Below average

Very Good Comments:


Good
Attitude in the work place
Average
Below average

3
SECTION D

Please comment on the applicant’s character in terms of personality and particular strengths
and areas in need of development ([Link], drive, judgment and organisational ability) :

Referees signature:

Print name:

Position:

Date and stamp:

References should be returned by email to [insert name] at [insert name]@[Link].


Thank you for your cooperation.

You might also like