Scorton Care Village

Private & Confidential

To whom it may concern,

Re: Reference Request for the post of ………………..

The above-named individual has applied to this Company for the above position and has provided
your name as referee in support of their application. The position will be working within a care
home with Vulnerable Adults. We should be grateful if you would take some time to the
complete the attached reference request.

In order to protect the public, the post for which this application is being made is exempt from
Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of
Offenders Act 1974 (exceptions) Order 1975. It is not, therefore, in any way contrary to the Act
to reveal any information you may have concerning convictions which could otherwise be
considered relevant to the applicant’s suitability for employment. Any such information will be
kept in strict confidence and used only in consideration of the suitability of this applicant for the
position where such an exemption is appropriate.

We thank you for your assistance in this matter.

Yours faithfully

Carmen Alina Bacoanu

For and on behalf of Scorton Care Village

Name of Applicant: Sangam Budhathoki

In what capacity do you know the applicant? She was working as an employee in our chirayu
Diagnostic and Health care center , she demonstrated excellent nursing skills,
professionalism and a strong commitment to patient care

Employer/Employee/Colleague

Other, please specify:

Please specify length of service: Start Date: 17/ 07 / 2021 Leave Date: 12 /11 / 2022
Rejoined 26 / 08 / 2023 Leave Date: 18/11/2024

Was their work attendance records satisfactory? Yes/No

If your answer is no, please state why?...................................................................................

.................................................................................................................................................

Please provide details of sickness and absences during the last 12 months. During whole 12
months of time period she was absent for 5 days due to cold and cough.

Where there any issues over the applicant’s conduct? Yes/No

If yes please specify ..............................................................................................................

Please tick the appropriate box:

Punctual 
Reliable 
Kind & Caring 
Capable 
Smart of appearance 
Works well with others 
Works well alone 
Trustworthy 
Honest 
Even tempered 
Communication skills 
Conscientious 
Scorton Care Village

Would you re-employ this person if a suitable vacancy arose? Yes / No

With reference to the Rehabilitation of Offenders Act 1974, are you aware of any convictions,
cautions or spent convictions with regard to the Applicant? Yes / No

If Yes, please specify……………………………………………………………………………...

……………………………………………………………………………………………………..

Do you know of any reason why we should not consider the applicant for the position applied
for?
If Yes, please specify ………………………………………………………………………………

Please indicate, in your opinion, if you feel the applicant would be able to fulfil the role as Care
Assistant, I would appreciate it if you could highlight any strengths or qualities you feel would
assist us in making a judgement:

I am confident that Sangam Budhathoki would excel in the role of a Care [Link] her
time at Chirayu Diagnostic and Health care center, I observed her exceptional compassion,
patience, and dedication to provide high-quality care to patients. She possess excellent
communication skills, which allow her to connect with patients and families, and she consistently
demonstrate a strong sense of empathy and understanding. She has a proven ability to manage
challenging situations with professionalism and grace, ensuring the comfort and dignity of those
in their care.

Name of Referee: Krishna Devkota

Date: 01/06/2025

Signature and Position within the Company: _________________________________

Please use Company Stamp:

In the absence of a Company Stamp, please attach a Company Letterhead or Compliment Slip.

If you have any queries regarding this reference request please contact us on 01748 812345
.