Character Reference Request Form

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Name of the person you are giving a reference for:

Your Name:

How do you know the applicant?

How long have you known the applicant for?

Please give your opinion on the applicant's characteristics:

1 being poor - 5 being excellent

Personal Appearance

Selected Value: 0

Temperament

Selected Value: 0

Honesty / Integrity

Selected Value: 0

Capability

Selected Value: 0

Trustworthiness

Selected Value: 0

Judgement

Selected Value: 0

In view of the possible vulnerable nature of the clients, health & social care work is excluded from the operation of the Rehabilitation of Offenders Act 1974. This means you may mention any convictions of the applicant of which you are aware:

As part of our reference process, we will give you a quick call to verify this reference, please confirm a telephone number to call you on below, thank you.

If you have any additional comments please feel free to write them below:

Today's Date:

Please sign below to confirm your reference:

All information provided by you will be held in confidence, subject to the Data Protection Act 2018.

Sales: 01252 265265

Please give your opinion on the applicant's characteristics:

Please contact us on 01252 265265 to see how Melody Care can help your loved ones remain independent at home

Aldershot
& Farnham

Alton &
Bordon

Camberley
& Frimley

Farnborough
& Fleet

Winchester
& Eastleigh

Live In Care

Aldershot
& Farnham

Alton &
Bordon

Camberley
& Frimley

Farnborough
& Fleet

Live In Care

Aldershot & Farnham

Alton & Bordon

Farnborough & Fleet

Camberley & Frimley

Aldershot & Farnham

Alton & Bordon

Camberley & Frimley

Farnborough & Fleet