Private and confidential
20/08/2010
Mr Nino Archie Labordo
Clinical Instructor
Remedios T Romualdez Medical Foundation College
Calanipawan
Phillipines
RE: Jake Cinco
The above named person has applied to register with Chrysalis Homecare. Chrysalis
Homecare is registered with the Care Quality Commission for the provision of domiciliary
care services.
As part of our stringent recruitment and vetting process all applicants must have recent,
relevant and professional references before they are able to work. The references must
be completed by the applicant’s manager within the organisation and must be signed
and dated by the referee. The references must be completed and returned on either your
organisation’s headed paper or stamped with your organisation’s stamp.
We would appreciate it if you would complete the enclosed reference form as
soon as possible, following the guidelines as detailed above. Please return
either in the free post envelope provided, or fax it back on 0208 686 8201
With reference to the Rehabilitation of Offenders Act 1974:
“In order to protect the public, the post to which application is being made is exempt
from section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the
Rehabilitation of Offenders Act 1974 (Exemptions) order 1975. It is not, therefore, in
any way contrary to the Act to reveal any information you may have concerning
convictions which would otherwise be considered as “spent”, in relation to this applicant,
and which you consider relevant to the applicant’s suitability for employment. Any such
information will be kept in strictest confidence, and used only in consideration of this
applicant for a position where such an exemption is appropriate”.
Please do not hesitate to contact me 0208 688 5825 if there is anything you would like
to discuss. Thank you for your time and attention, we look forward to receiving your
reference.
Yours sincerely
Barbara Parris
Recruiter
V1AUG09
Reference request form
Reference requested
This section is to be completed by the Chrysalis Please affix the official stamp here. This reference will
Homecare employee prior to sending out. not be considered valid unless accompanied by an
Reference requested from: official stamp or stationery e.g. a compliments slip.
Name: Mr Nino Archie Labordo
Remedios T Romualdez Medical
Foundation College
Postcode:
Applicant details
Title: Forename: JAKE Surname: CINCO
Dates of employment
from: to:
Position held:
How do you know this person? My student in the College of Nursing
Reason for leaving: Graduated the BSN degree
Would you re-employ this candidate (subject to equal opportunities)? Yes x No
If no, please state your reason
How would you rate the applicant’s ability?
Cause for Don’t
Excellent Good Adequate Poor
concern know
Reliability X
Communication skills X
Patience/listening X
skills
Honesty and integrity X
Ability to use initiative X
Ability to carry out X
tasks
Knowledge of care X
practice
Presentation X
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Are you aware of the applicant
YES! Mr. Cinco was been my student.
having any criminal convictions?
NONE
Please highlight any positive Easy to deal with
aspects of the applicant’s work.
Committed and hardworking
Good personality
Were there any concerns about None
any aspects of the applicant’s
work?
Please detail the main duties of the post and attach a job description if possible.
Student Description at Clinical Setting;
Audits, assesses and submits reports of the patient (Nursing
Care Plan, Pharmacology Sheets, Laboratory Reports, Patient
Comprehensive History)
Go on duty 15 minutes before the shift. In complete uniform
and paraphernalia’s.
Attends the endorsement and nursing rounds.
Take assigned patient. Assess, plan, implement and evaluate
nursing care rendered.
Reports and updates nursing staff and health care team
including the attending physician regarding patient condition.
Carries out doctors order properly ( Medication administration,
referrals and collaboration, therapeutics and management)
Reports care rendered to clinical instructor.
Attends pre and post conference, bedside clinics and ward
evaluation.
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How many sick days did the applicant have in the last 12 months?
Are you aware of any periods of long term sickness? Yes No x
If yes, please detail:
Declaration
Print name: NINO ARCHIE S. LABORDO, RN, MSc Signature:
Position: Clinical Instructor –RTRMF College of Date: 8-27-2010
Nursing, Tacloban City
V1AUG09
