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Mumby’s Homecare Support Ltd Noah’s Ark Wantage Road Frilford Oxon OX13 5NY Tel: 01865 391187 Fax : 01865 391226 www.mumbys.com Request for Reference

Date:

Dear Xacom S.L Online Manager 4 th January 2011 The following person has applied to register with Mumby’s Homecare Support Limited in the capacity of Care Worker and has given your name as a referee. Name Luis Caldery Previous Surname Address Calle Miramar Boja Casa 3 Bloque 1 Almuneca Spain Post Code 18690 We would be grateful if you would answer the following questions. All information provided will be treated in the strictest confidence. In what capacity do you know the applicant? As an Online Manager he was in charge of the corporative website among another communication and marketing duties. How long have you known the applicant? Years X Months Did you employ the applicant? Yes X No Would you re-employ the applicant? Yes

X

No

Sickness and Absence How many days sickness did the applicant have during the period that he/she was employed by you? Did the applicant have any unauthorised days of absence during the period that he/she was employed Yes No by you? X If you have answered yes to the previous question, how many days? We would be grateful if you would indicate your opinion on the characteristics of the applicant in respect of the categories listed below. Excellent Good Average Poor Clinical skills Reliability/Timekeeping

X

Honesty

X

Ability to work within a team framework

X

Communication skills

X

Enthusiasm/Motivation

X

Initiative

X

Ability to take charge (if appropriate)

X

Other Relevant Information Please use this section to make any other comments that you feel are relevant and that may be helpful to us in making a decision regarding this person’s application for employment with Mumby’s Homecare Support Limited (please continue on a separate piece of paper and attach it to this form if necessary)


Working as an Online Manager at Xacom Comunicaciones, Luis Caldery showed himself to be a very proactive person with great communication skills. One of his strengths is the team work capacity. Knowing him I think he is an excellent candidate for your company.

Rehabilitation of Offenders Act 1974 By virtue of the Rehabilitation of Offenders Act 1974 (Exemptions)(Amendments) Order 1986, the provision of sections 4.2 and 4.3 of the Rehabilitation of Offenders Act 1974 do not apply to any employment which is concerned with the provision of health services and which is of such a kind as to enable the holder to have access to persons in receipt of such services in the course of his/her normal duties. Your answer to the following question must include any ‘spent’ convictions.

As far as you are aware, has the applicant ever been convicted of a criminal offence? Yes Signed: Luis Santos Calderón Please print your name:

No

X

Date: 19/01/2011 Position: CEO

On behalf of Mumby’s Homecare Support Limited we would like to thank you very much for taking the time to complete this form and respectfully ask that you return it at your earliest convenience. Thank you for your assistance. Please stamp with your official company stamp or include a compliment slip in your reply. Yours sincerely

Mrs Kezie Heath – Care Manager pp Ann Mumby RN Director Mumby’s Homecare Support Limited.

Updated September 2010

FOR OFFICE USE Telephone call follow up prior to confirmation of engagement Date_______________________ Confirmed with_______________________ Signature___________________

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