P A CARE SERVICES LTD

50 CAMBRIDGE ROAD
Tel: 0203 561 9663
www.pacareservices.com
CHARACTER REFERENCE FORM

Referrer Name:__ claudine.kimwanga ____________________________ Relationship to Applicant:

_____Supervisor______________

Phone:______________________________________ Email: _____________________________________

Date: ________________________________________

Re: Character Reference Request for: [APPLICANT NAME]

Please complete the Character form below to the best of your knowledge. Thank you for your assistance.

Name of Applicant …………Tainia Goncalves …………………………….………………………………………………….

Address: ……37 hoskins close

London
E16 3rh …………………………………………………………………………………………………

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1. In what capacity have you known the applicant?

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We worked together at St Mary university and I helped supervise Taina.
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2. How long have you known the applicant? ………11 years…………………………………………..

3. What words will you use to describe the applicant’s character?

…………………Taina is good at team work, good with completing outgoing tasks and very reliable. ………..
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4. Please comment on the applicant’s

 Honesty/Trust Worthiness……………………………………………………………………...
Taina is honest and trustworthy.
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 Reliability …………Tania is reliable; she was able to pick shifts when the company needed her to step in.
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  Personality ………………………………………….………………………………………….

Please rate applicant EXCELLENT VERY GOOD AVERAGE NOT SATISFACTORY

GOOD
EFFICIENCY Excellent
CARING Excellent
TIME KEEPING
ABILITY TO COMMUNICATE Very
good
RELATIONSHIP WITH Excellent
OTHERS
CONDUCT Excellent

5. Are you aware of any health problems that may affect the applicant working in social care situation? If yes, please
comment: NO 

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6. Are you aware of any previous convictions (spent or otherwise) that this applicant may have? If yes please give details:
NO 

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7. Do you know of any reason why this applicant should not engage in a social care setting? If yes please give details:
NO 

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8. General Comments: Why would the applicant make a good health care worker / support worker?

………………Tania will be a good applicant you’re your job due to her experience. Tania took fulltime care of her elderly
mother until her sudden death last year on may 2018. Tania was able to wash, prepare food, give medication, and also
support her mother when she had health appointments. …………..
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Please feel free to use extra sheet where applicable.

Signed ………………CK………………………… Date ……………27/02/2023………………………….

Name …………… claudine.kimwanga ……………………………… Contact Number ………………………………

FOR OFFICE USE ONLY

Confirmation of Reference:
Name of Referee / Relationship:
Acceptable
Unacceptable
Date: ____________________ Signature: ______________________