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Staff Reference Form

Confidential reference for*
First Last
For the position of*
BACKGROUND
How long have you known the candidate and in what capacity?
PERSONNEL MATTERS
Candidate's current position*
Dates of the candidate's employment with you (month and year)/dates of course undertaken:*
Extent of the candidate's duties & commitments when working with you*
During their employment/course has the candidate carried out their duties and/or commitments to your satisfaction?*
If NO, please explain the reasons for your dissatisfaction.
During his or her employment/course has the candidate presented themselves professionally with colleagues and those with whom they dealt?*
If NO, please explain your answer
Do you believe that the candidate is physically and mentally fit to work with a large group of children*
If NO, please explain your answer
SUITABILITY FOR THE POST
Do you believe that the candidate is suitable for the job they have applied for? (Please see the job description attached to this form)*
DISCIPLINARY AND CHILD PROTECTION CONCERNS
Has the candidate been subject to any disciplinary procedures in this employment/course which led to a disciplinary sanction?*
If YES, please specify
Has the candidate been subject to any disciplinary procedures relating to the safety and welfare of children or young people where the allegation was unfounded?*
If YES, please specify
Have there been any allegations or concerns expressed about the candidate that relate to the safety and welfare of children or young people?*
If YES, please give details and specify whether the issue was investigated and the outcome of any such investigation.
Would you employ this person again?*
SAFER RECRUITMENT DECLARATION
I am not aware of any reason, behaviour or impediment concerning the above candidate which would prevent that candidate being appointed to a post and having substantial and unsupervised access to children and young people on a regular basis.
Name
First Last
Position*
Phone*
Date*
DD slash MM slash YYYY

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Staff Reference Form

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