Reference Form

Your name has been provided by the applicant name above, who has applied to Your Nurse Limited to be supplied as an Agency Worker in the locum position. Please provide the following information regarding the applicant and tick the appropriate box. Please return the form to us via your professional email address or accompany it with Organisation stamp for his form to be deemed valid

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This document field is required

DETAILS

This name field is required
This surname field is required
This refree name field is required
This refree surname field is required
This job title field is required
This job brand field is required
This hospital field is required
This ward type field is required
This contact field is required
This date field is required
This date field is required

Yes No
This field is required

SKILL/RATING

Suitability*

Excellent Very Good Good Satisfactory This field is required

Knowledge*

Excellent Very Good Good Satisfactory This field is required

Ability to work under pressure*

Excellent Very Good Good Satisfactory This field is required

Interpersonal Skills*

Excellent Very Good Good Satisfactory This field is required

Time-keeping*

Excellent Very Good Good Satisfactory This field is required

Consultation skills (e.g. patient feedback)*

Excellent Very Good Good Satisfactory This field is required

Co-operation with other staff*

Excellent Very Good Good Satisfactory This field is required

Presentation*

Excellent Very Good Good Satisfactory This field is required

Trustworthiness*

Excellent Very Good Good Satisfactory This field is required

Reliability*

Excellent Very Good Good Satisfactory This field is required

Computer Skills*

Excellent Very Good Good Satisfactory This field is required
This detail field is required
This name field is required
This date field is required
This signature field is required
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