Reference Request Form

Thank you for providing a reference. Please complete the form below. All responses are treated confidentially and securely.

Fields marked * are required. All submissions are processed securely and in accordance with our Privacy Policy.

About the Applicant

Applicant First Name *

Applicant Last Name *

Position Applied For *

Dates of Employment *

Your Details

Your Full Name *

Your Job Title *

Organisation *

Your Email *

Reference Questions

Describe their main role and responsibilities *

How would you describe their reliability and attendance? *

How did they interact with service users / clients? *

Any disciplinary action, conduct or safeguarding concerns? *

Would you re-employ this person? *

Additional comments

I confirm this reference is accurate and given in good faith. I consent to Lamora Healthcare processing it in accordance with their Privacy Policy.

✓ Your reference has been submitted securely. Thank you for your time.