Care Assistant/Support Worker Role

  • Form

Employer Reference Request

Applicant's Name

In what capacity was the applicant employed by you?

For how long was the applicant employed?

Date From

Date To

How many days of absence due to sickness has the applicant had in the last 3 years?

Please rate the applicant in terms of their:



Quality of Work

Relationships With Others

How many weeks (if any) of Parental Leave has the Applicant taken?

Are there any reasons or circumstances which would make it undesirable for us to consider the application?

If YES, please provide details.

Would you re-employ the applicant?

What was the Applicant’s reason for leaving your employment?

In the event that the applicant makes a subject access request under the General Data Protection Regulation (GDPR), to view the personal data held about him/her, please confirm whether you wish us to contact you to obtain your explicit consent prior to giving him/her access to this reference.

Your Name

Your Company

Your Position