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Professional Reference Request Form Updated 1
Professional Reference Request Form Updated 1
Name of Applicant:
The above has given your name as a referee. No applicant can be offered a position with us until we have received at least
two independent references, one of which has been requested from you.
Please would you complete the details below commenting on their suitability for this position. We have enclosed
the job description and person specification for the role.
All referees are responsible for ensuring that any reference provided is entirely accurate and does not contain any
material misstatement or omission. Any information that you give us will be treated in confidence, subject to any
duty to disclose the information we may have under the Data Protection Act 2018.
Work history
Job Title (s) Date from Date to
Absence
How many days sickness absence did they have in the two years before leaving? About 20 days in total
How many periods of sickness absence did they have? 2 periods in total
Reason for absences:_Sickness and ill health
a) Does the applicant have any disciplinary actions on their file or are they subject to an investigation or
disciplinary hearing? Yes ☐ No ✅ (Please tick)
b) Has the applicant been subject to any formal action in relation to discipline or competence at any time?
Yes ☐ No ✅ (Please tick)
c) Please give brief details of their main duties and responsibilities, and number of people
managed/supervised:
Vidushi worked as a part of the crisis-intervention team to systematically reach out, respond and offer
moral, social, legal and psychological support to women who are victims of domestic violence. As a part
of the crisis intervention team she took on the role of a case-worker and her role included conducting risk
assessments, creating risk management plans and advocating for the rights of women with both
governmental and non-governmental bodies. She also managed Vimochana’s campaigns to offer trauma-
informed mental health counseling to survivors of gender-based violence. This entailed creating and
cordinating a city-wide network of women’s groups and mental health service providers. Additionally, she
was engaged in drafting policy papers and opinion pieces for the organisation.
She supervised 2 employees in the crisis-intervention team.
d) Did they carry out their duties satisfactorily? Yes ✅ No ☐ (Please tick)
e) Please comment on the candidate’s main strengths and areas for development. f)
Strengths: Vidushi was a very hard-worker who required minimum supervision. She had an
in-depth understanding of the feminist struggles in India and worked tirelessly to further the vision and
mission of the organisation. She was a very empathetic case wroker who tailored her advocacy to the
particular needs of the women while centring their voices. She was great at adapting to new projects and
team. She was a good team player and had created some
long-lasting networks and partnerships for the organisation.
Please can you consider the applicant and give your assessment, in confidence, of their knowledge and abilities under
the following headings. Some of the headings may not be relevant, if this is the case please mark not applicable. You
may want to attach a separate letter of reference where your personal knowledge of the applicant does not cover
these areas fully.
Quality of work ✅
Quantity of work ✅
Attitude to work ✅
Professional knowledge, ✅
skills and abilities
Ability to accept ✅
responsibility
Ability to maintain ✅
professional boundaries and
confidentiality
a) Attached is a job description for the position the applicant has applied for. Please use this space to comment
on their suitability for the post.
In myother
b) Any opinion, Vidushi
comments youwould
wish be an excellent
to make fit for
regarding the the position of the Independent Domestic Violence
applicant?
Advocate. At Vimochana she had a similar job profile where she worked closely with survivors of gender-
based violence and provided crisis intervention support. Her work at Vimochana has equipped her with skills
to provide emotional support to women and children while centering their voices and advocating for their
needs. I am confident that her work with developing the mental health network will help her navigate, create
and maintain partnerships and work within a
multi-agency framework. She also conducted severak workshops and provided training to frontline
government responders to deepen their understanding of gender-based violence. Lastly, she was responsible
for contributing to qualitative and quantitative reports of the organisation and participate in periodic case
reviews.