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Connect Nursing Ltd
Connect Nursing
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020 8988 1110
Complex Care
Acquired Brain Injury
Arnold-Chiari malformation
Ataxia or Friedreich’s ataxia
Autonomic Dysreflexia
Bowel Care
Catheter Care
Cerebella ataxia
Charcot-Marie-Tooth disease
Creutzfeldt-Jakob disease
Epilepsy
Inclusion body myositis
Lambert-Eaton myasthenic
Learning Disability
Long Term Ventilator
Motor Neurone Disease
Multiple Sclerosis
Multiple System Atrophy
Muscular Dystrophy
Myasthenia gravis
PEG feeding
Physical Disability
Post-polio syndrome (PPS)
Prion diseases
Progressive Supra Nuclear Palsy
Spinal Cord Injury
Tracheostomy
Home Care
Home from hospital
Dementia care
Elderly care
Medication administration
Emergency home care
Support for younger people
Respite Care
Palliative Care
Live in care
About us
Quality assurance
Temporary staff
Contact us
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Complex Care
Acquired Brain Injury
Arnold-Chiari malformation
Ataxia or Friedreich’s ataxia
Autonomic Dysreflexia
Bowel Care
Catheter Care
Cerebella ataxia
Charcot-Marie-Tooth disease
Creutzfeldt-Jakob disease
Epilepsy
Inclusion body myositis
Lambert-Eaton myasthenic
Learning Disability
Long Term Ventilator
Motor Neurone Disease
Multiple Sclerosis
Multiple System Atrophy
Muscular Dystrophy
Myasthenia gravis
PEG feeding
Physical Disability
Post-polio syndrome (PPS)
Prion diseases
Progressive Supra Nuclear Palsy
Spinal Cord Injury
Tracheostomy
Home Care
Home from hospital
Dementia care
Elderly care
Medication administration
Emergency home care
Support for younger people
Respite Care
Palliative Care
Live in care
About us
Quality assurance
Temporary staff
Contact us
Reference Request
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Reference Request
Step 1 of 6 - Applicants Details
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Applicant Name
*
Job title whilst employed with you
*
Referee
Full Name
*
Email address
*
Type of reference?
*
Personal reference
Work reference
Personal reference
*
Company Details
Company Name
*
Address
*
Street Address
Postcode
Still employed?
*
Yes
No
Start Date
*
Date Format: DD slash MM slash YYYY
End Date
*
Date Format: DD slash MM slash YYYY
Reason for Leaving
*
Please now rate specific area for this person's work performance
Reliability + Punctuality
*
Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Honesty + Integrity
*
Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Standard of work
*
Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Ability to work with others
*
Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Ability to follow instructions
*
Unsatisfactory
Satisfactory
Good
Very Good
Excellent
Is this person part of any current disciplinary procedure or investigation?
*
Yes
No
Subject to company policy would you re-employ this individual?
*
Yes
No
If not why not?
Do you have any other comments that might assist us when assigning this person?
Do you know of any reason why this applicant would not be suitable to work or have contact with vulnerable people, including children, within a care organisation?
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