Reference Check

Reference(Required)

First Name Last Name

Email(Required)

Phone(Required)

Who are you doing a reference for?(Required)

First Name Last Name

What is your relationship to them?(Required)

Describe your relationship(Required)

How did you initially meet them?(Required)

When did they start working for/with you?(Required)

When did they finish working for/with you?(Required)

What was the age of the youngest child(ren) they cared for, whilst working for/with you?(Required)

(E.g. newborn, 3 months, 6 months, 12 months, 18 months, etc)

What were their responsibilities whilst they worked for/with you?(Required)

Did they have sole or shared care? Please describe the blend of care(Required)

(Sole means they were responsibile for looking after children by themselves)

Describe their punctuality or lack there of(Required)

Describe how you perceive their honesty and integrity(Required)

Describe their communication skills(Required)

Describe how they respond to feedback and direction(Required)

Was there ever a complaint about their performance, safety or behavior? (If so please explain)(Required)

What are their attitudes to child's safety and children's rights?(Required)

(Please describe specific measures, policies and philosophies they follow to ensure children's physical and emotional safety)

What is their approach to managing children's behaviour?(Required)

(Please provide an example of a time where a child may have been misbehaving, and how they handled/alleviated the situation)

Describe a time when they have impressed you(Required)

What has their most significant achievement(s) been?(Required)

(Whilst working for/with you?)

Describe their strengths and weaknesses(Required)

Describe any areas for improvement you may have observed (such as where support and training was required)(Required)

Why did they leave your employment?(Required)

Would you employ them/work with them again?(Required)

Would you recommend them to work with families in private homes?(Required)

I confirm that all information provided within this reference check is true(Required)

Yes

Would you be happy for us to share any of the information or feedback you have provided during this reference check with the applicant?(Required)

Any information shared with the applicant would only be used where appropriate to support professional development, identify training needs, or address matters relating to the safety and wellbeing of children.

Yes, all of my feedback may be shared.

Yes, all of my feedback may be shared, however I would prefer my identity not be disclosed.

Yes, but only some of my feedback may be shared (please specify below):

No, I would prefer my feedback remain confidential.

Please outline which feedback should remain confidential:(Required)

And if you feel comfortable, please share why you wish for it to be confidential.

Please provide further details:(Required)

Please enter N/A if you wish not to detail. However, this information would be greatly appreciated!

I am happy to be contacted by ALHCA if they require any further information(Required)

Yes

Reference Check

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