APPENDIX C - REFERENCE PROFORMA – TEACHING STAFF
Name of Applicant: Sruthi Jayesh Position Applied for: Secondary Chemistry teacher
Name of Referee: Deepa Praveenth Date: 24/12/2021
If you are a representative of the Applicant's current or previous employer, please complete and sign the form.
And if necessary, please provide further details on a separate sheet.
What is the name of your
Leaders Private School
organisation?
What position do you hold?
If you are not the Head of Department,
please ensure that this reference is TGT Mathematics
countersigned by the Head of
Department.
How long have you worked/did you
Two years & 4 months
work with the Applicant?
Please confirm the Applicant's role
PGT Chemistry
and/or duties.
Please confirm the Applicant's dates Employment start date: Employment end date:
of employment 01/09/2019 09/12/2021
If the Applicant has ceased
employment with you, please
confirm the reason for the
termination of the Applicant's
employment.
If the Applicant was dismissed,
please explain the reason for the
Applicant's dismissal and the
surrounding circumstances.
Needs
Please rate the Applicant against the substantial
Needs
Outstandin
developme
developme Acceptable Good
g Comments
following criteria: nt
nt
Attitude to work
Passion for teaching and learning
Attendance/punctuality
Reliability
Working relationships with other
employees
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use, distribution, transmission, alteration or reproduction of this document, or any part of it, may result
in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under
the law.
Relationships with parents
Relationships with students
Planning/preparation for lessons
Ability to implement planned lessons
effectively
Classroom management
Marking and feedback
Commitment to school events
Extra-curricular involvement
Technology competency
Curriculum knowledge - Early
Years/Primary or equivalent
Subject knowledge of English
Subject knowledge of Maths
Subject knowledge of Science
Main Subject : Chemistry
Subject knowledge specialist
Secondary Subject:
Is/Was the Applicant? (please tick
relevant posts) Curriculum Coordinator
Form Tutor
Head of Department
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use, distribution, transmission, alteration or reproduction of this document, or any part of it, may result
in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under
the law.
Head of Year
Other (please specify)
Please confirm the number of days'
absence the Applicant took during
the final 12 months of their
employment.
Yes
*Has the Applicant been the subject
of disciplinary proceedings during
No
the last 12 months of their
employment? If yes, please provide
details of the allegation(s) against
the Applicant and the outcome of the
proceedings.
Please provide details of any
allegations or concerns that have
been raised about the Applicant
which relate to the safety and
welfare of children or young
people.
Has the Applicant been the subject
Yes
of disciplinary proceedings
(including but not limited to verbal or
No
written warnings) involving issues
related to the safety and welfare
of children or young people? If
yes, please provide details of the
allegation(s) against the Applicant
and the outcome of the proceedings.
Yes
With reference to the attached Job
Description and Person
No
Specification, are you satisfied that
the Applicant has the ability and is
suitable to undertake this role? If
no, please give specific reasons for
your concerns.
Based on your knowledge and
experience of the Applicant, do you
have any reason to believe that
he/she is unsuitable to work with
children, and where applicable,
vulnerable adults? If yes, please
provide details.
Company Confidential: This document is protected by international copyright laws. Any unauthorised
use, distribution, transmission, alteration or reproduction of this document, or any part of it, may result
in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under
the law.
Yes
No
Yes, without reservation
Would you be willing to re-employ
the Applicant? If no, please explain Yes, with reservation
why.
No, I would not wish to re-employ
Please submit a summary
paragraph to describe the Applicant
overall, or any other comments you
would like to share.
Signed:
Countersigned by Principal (if
applicable)
Date:
Company Confidential: This document is protected by international copyright laws. Any unauthorised
use, distribution, transmission, alteration or reproduction of this document, or any part of it, may result
in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under
the law.
