Reference FormCare Worker Name* First Last Reference Name* First Last Reference Phone*Reference Email* This report was obtained* In writing By email By telephoneReference Taken By* First Last Can you tell me what your relationship with (NAME) is? How long have you known them?*Where did you work? (Confirm place they worked is same place listed by care worker) What was your role and (NAME's) role?*How long did (NAME) work at the company for? Why did they leave the company?*Does (NAME) have any skills or experience that would be relevant for disability or aged care work?*In your experience, does (NAME) provide quality customer service?*Is (NAME) organised and reliable?*COMPULSORY QUESTION. Was there any aspect of (NAME's) behaviour or actions that would make him/her UNSUITABLE for working with children, aged or vulnerable communities?*Additional Questions / Comments This iframe contains the logic required to handle Ajax powered Gravity Forms.