Dear Sir/Madam
RE: Yabesera Meles
24/09/2021
The above-named applicant has applied to Practical Care Solutions Ltd for the position of Health Care Assistant
and has given your name as someone whom we may contact for reference. We would be very pleased, therefore if
you would complete the attached reference form and return it at your earliest convenience
Your reply, including any information given out to us of course be treated in the strictest confidence
We do not normally acknowledge receipt of references so we would like to thank you in advance for your
assistance in this matter.
Yours Sincerely
Perpetua Levins
Manager
Reference request form (previous employer)
To: Company:
Reference for: Yabesera Meles
Period of employment From: To:
Job Title
Has the applicant been subjected to any disciplinary action within the last twelve months? No
If Yes please give details:
Please complete the following table by ticking the appropriate boxes:
Excellent Good Average Poor
Quality of work
Team working skills
Ability to work under pressure
Communication skills
Ability to work on own initiative
Ability to work flexibly
Timekeeping
Loyalty
Trustworthiness
Concern for others
Sickness/Absence
Relations with others
Honesty/integrity
Would you re-employ this person Yes
If you would like to make any further comments please attach a separate sheet.
Thank you for your assistance.
Completed by (print name)
Signature Date