Nanny Reference Request Form

Nanny Reference Request
You've been listed as a reference. Your feedback will help our family immensely in selected whether or not the candidate is a good fit for our family. We appreciate honesty and all of your time.
REFERENCE REQUEST FOR*
Your Name & Position*
Relationship with candidate*
Company name & address where worked with candidate. If you are a personal candidate please explain how you met and nature of ongoing engagement/relationship. *
1. Employment Details
When did you first meet applicant (approx) *
DayMonthYear
Date
How long did you work with the applicant?
Candidate’s job title*
Reason no longer working together?*
Did the applicant take care of your children?*
YesNo
Would you re-hire the applicant to work for you?*
YesNo
Please explain why you wouldn't rehire?
What did applicant do well?*
What (if any) issues arose during the care of your children while under the applicant's care?
If you are a friend, previous co-worker or previous supervisor, would you hire/re-hire the applicant to work for you?*
YesNo
Comments/further information
Did the applicant cook/prepare meals for your children?*
YesNo
Quality of food*
I/we loved it!Some of the best food I've ever tasted!GoodSatisfactory (just ok)Not the best
General housekeeping and chores*
SuperbGoodJust okayDid not meet my expectationsN/A
2. Please Comment On The Following
General Conduct*
ExcellentGoodSatisfactoryPoor
Reliability*
ExcellentGoodSatisfactoryPoor
Timekeeping*
ExcellentGoodSatisfactoryPoor
Communication Skills*
ExcellentGoodSatisfactoryPoor
Relationship with colleagues/other staff members*
ExcellentGoodSatisfactoryPoorNot Applicable
Quality of overall work*
ExcellentGoodSatisfactoryPoor
Was the candidate’s honesty and integrity ever been brought into question during the time you all worked together/since you've known the candidate? *
Level of performance with childcare*
ExcellentGoodSatisfactoryPoor
What areas do you feel the candidate needs to improve?
CommunicationProfessionalismPunctualityEthicsPunctualityDocumentationEffeciencyOther
Please explain further.*
Are you aware of any suspicious proceedings, Policy investigations or disciplinary action?*
What challenges did/have you faced in your relationship with the candidate?*
Additional comments. If you have ticked satisfactory or poor for any of the above please provide us with further explanatory information
I declare that to the best of my knowledge the information I have given in this reference is correct and complete*
I Agree
E-mail
example@example.com
Phone Number
Should be Empty: