Rosewood Lodge Reference Form

To: Ademola folarin

Position: Manager

Company: Top up 24 Ltd (Voyage Asia (previously)

Applicants Name: Miss Maryam Bassey

Post Applied For Night Care Assistant

1. Please supply the dates the applicant was employed with your company
Start Finish

2. In what position was the applicant employed

3. In your opinion is the applicant:

a. Reliable  Yes  No b. Punctual  Yes  No

c. Capable  Yes  No d. Able to get on  Yes  No

well with others
4. Please comment on the applicants experience in relation to the job description for
the post applied for

5. In your opinion what makes the applicant a suitable candidate for the post applied
for

6. Does the applicant work well under pressure

 Yes  No
7. Does the applicant work well without supervision
 Yes  No
8. What is the applicants absence record during their employment with you

Rosewood Lodge Reference Form

 Number of days sick leave Number of absences

9. Has the applicant been subject to any disciplinary procedures during their
employment
 Yes  No If yes please give details

10. Are you aware of anything in connection with conduct, integrity or health which
might make the candidate unsuitable for appointment?

11. Would you re-employ this person

 Yes  No If no please give details

12. To the best of your knowledge why did the applicant leave your employment

13. Please give any additional information that you feel would be of use to us when
assessing the candidate’s suitability for the post applied for. (Continue on a
separate sheet if necessary)

Signed__________________________ Print Name_________________________

Position _________________________ Date_____________________________

Company Stamp:

If a company stamp is not available please enclose a signed compliment slip. Failure to provide either
will unfortunately invalidate this reference.

Rosewood Lodge Reference Form