Recruitment Services

Trust Headquarters
1 Armstrong Way
Southall
Middlesex
UB2 4SA

Monday, 21st October 2019

Private and Confidential

Mr Michael Akinyemi
Sterling Standard Care Group
Suit 6, Barkat House, 116-118 Finchley Road, London, NW3 5HT
London
NW3 5HT
United Kingdom

Dear Mr Michael Akinyemi,

Re: Raybel Colmenares Rodriguez - [222-Bank-05] Bank Security Assistant

The above named has been offered the post of Bank Security Assistant and has given permission for
us to approach you for a reference. I would be grateful if you could let me have your opinion regarding
her suitability for the post by completing the attached reference request form.

Your reply will be treated in the strictest confidence and I would greatly appreciate a swift response.

It is preferred that you fulfill this request by using the on-line form available at
https://apps.trac.jobs/references/ using the reference ID 17211911 / NK66030302. Alternatively you
can print out the attached form and return it to us by fax to 03333 44 88 22.

If you do not want to use the online system or the form provided please reply to this email with your
own form or letter attached.

It should be noted that under the Data Protection Act candidates may request access to any
information that is held on them.

May I take this opportunity to thank you in anticipation of your assistance in this matter.

Kind regards,

Mrs Vaneeta Brown

Recruitment Team Leader
Tel: 0208 354 8885

Page 1 of 6
Page 2 of 6
 To fill out this form on-line, please visit https://apps.trac.jobs/references/ and enter the following reference ID:
17211911 / NK66030302
Alternatively, you may return this form by faxing it to 03333 44 88 22.
Please include only one form per fax, and use "fine" or "superfine" mode where possible.

Applicant details

Applicant name Miss Raybel Romani Post applied for Bank Security Assistant
Colmenares Rodriguez [222-Bank-05]

Referee Mr Michael Akinyemi Organisation Sterling Standard Care

Group

Your job title Manager

Reference form

About the applicant

Dates Raybel worked for your From [ M M / Y Y Y Y ] To: [ M M / Y Y Y Y ]
organisation

Please confirm Raybel's most recent

job title and grade

What hours did Raybel work?

I.e. Full Time 37.5 per week, Part Time 20hrs/wk, Full Time 160 hours per
month or not applicable if they were a student on a course.

Reason for leaving (if known)

Main tasks and responsibilities

Please provide details of Raybel's sickness record over the last two years of employment

Reference ID: 17211911 / NK66030302 Page 3 of 6

 Number of days

Number of occasions

Comments

Has Raybel been the subject of any No

substantiated disciplinary action Yes
whilst in your organisation's
employment?

If yes — please provide details,

including the outcome

Is Raybel currently the subject of any No

disciplinary actions or the subject of Yes
a current investigation?

If yes — please provide details

Are you aware of any child protection No

allegations or concerns that have Yes
been raised against Raybel which
relate to the safety or welfare of
children, young people or vulnerable
adults?

If yes — please provide details

The post is exempt from the provision of Section 4 (2) of the Rehabilitation of Offenders Act, 1974 by
virtue of the Rehabilitation of Offenders Act (exceptions) Order 1975. Applicants must therefore declare
all cautions, criminal convictions, criminal convictions pending, warnings or reprimands both within and
outside of any ‘unspent’ period.

Do you know of any cautions, No

criminal convictions, warnings or Yes
reprimands in respect of the
applicant?

Page 4 of 6 Reference ID: 17211911 / NK66030302

 If yes — please provide details

What are Raybel’s strengths in the

workplace?

What current development needs

have been identified for Raybel to
work towards?

On reading the job description for the Yes

position that Raybel is applying for Unsure
would you consider that Raybel is No
capable of carrying out this post?

If unsure or no — please give

reasons for your answer

Would you re-employ Raybel in a Yes

similar role / offer a further period of No
study?

If no — please state why

Any other comments?

Declaration

Are you the person named above as No

referee?

Reference ID: 17211911 / NK66030302 Page 5 of 6

 This reference request was sent without a referee name. Please provide your name, or the name of the
person responsible for giving this reference.

Your name

Your job title

Organisation name

Address line 1

Address line 2

Address line 3

Town / city

County

Postcode

Country

Telephone

Fax

Email address

Your relationship to the candidate Employer / Line Manager

Course Tutor / School or College Principal
Mentor
Personal / Character Reference

Raybel has stated that the reference From [ 09 / 2018 ] to [ 08 / 2019 ]

covers the period from:

Please confirm the period that this From [ M M / Y Y Y Y ] To [ M M / Y Y Y Y ]

reference relates to:

The above information has been provided without prejudice and is correct to the best of my knowledge and
belief.

Signed: _______________________________________ Date: D D / M M / Y Y Y Y

Data protection

This form contains personal data as defined by the Data Protection Act 2018 (as amended by the General Data
Protection Regulation 2018). This data has been requested by West London NHS Trust exclusively for the purpose
of recruitment. West London NHS Trust must protect any information disclosed within this form and ensure that it is
not passed to anyone who is not authorised to have this information.

Page 6 of 6 Reference ID: 17211911 / NK66030302