Reference Request Form

Deepak Kumar
National Disability and Mental Health Srevices
M:0487197957
admin@ndmhs.com.au
www.ndmhs.com.au

    Reference Request

    Thank you for taking the time to complete this reference for .
    Please read and check the consent statement, then confirm or update your details entered by .
    On the following page you will be asked a series of questions about including your opinion on their work experience and performance.

    NDMHS Consent Statement

    NDMHS compiles your answer into a reference report for employer and will be saved in his files.
    By Checking the consent box below, you agree to the following statements:

    • I consent to NDMHS using my answers to create a reference report which will be shared with NDIS auditors if needed.
    • I am aware that the answers given may, under certain circumstances and at the express request of the candidate, be dissolved to the candidate and I believe my answer to be accurate and fair.
    • I consent to my information being stored in datacenters in Australia for the sole purpose of creating a refrence report.
    • I agree to the privacy policy.

    Your Details

    Update any details that are incorrect.




    Working Relationship Details





    Reference Request for

    Please answer the following questions compiled by NDMHS

    ABILITY TO PERFORM IN THE ROLE

    Can you please rate from 1 to 5 on the following attributes: (1 being Poor to 5 being Excellent)

    Turn your phone sideways to answer the following questions
    Poor N/A 1 2 3
    Clinical judgement and decision-making skills PoorNeutral123
    Mandatory reporting skills PoorNeutral123
    Ability to follow policies and procedures PoorNeutral123
    Ability to lead, mentor or guide more junior staff members PoorNeutral123
    Ability to manage the behaviour of patients/residents PoorNeutral123
    Ability to administer medications PoorNeutral123
    Observation skills and ability to de-escalate issues if required PoorNeutral123
    Use of electronic based care or medication systems PoorNeutral123
    Ability to manage pressure/busy workload? PoorNeutral123
    Willingness to ask for help if needed PoorNeutral123

    WORK ETHIC

    Can you please rate from 1 to 5 on the following attributes: (1 being Poor to 5 being Excellent)

    Turn your phone sideways to answer the following questions
    Poor N/A 1 2 3
    How would you rate punctuality and reliability? PoorNeutral123
    How would you rate organisational skills? PoorNeutral123
    How would you rate initiative? PoorNeutral123

    COMMUNICATION AND INTERPERSONAL SKILLS

    Can you please rate from 1 to 5 on the following attributes: (1 being Poor to 5 being Excellent)

    Turn your phone sideways to answer the following questions
    Poor N/A 1 2 3
    What is communication with residents and families like? PoorNeutral123
    How would you rate relationship with colleagues? PoorNeutral123


    EMPLOY-ABILITY



    Your Signature

    Thank you for completing the reference for .

    As part of our security protocols, we require a digital signature. Please enter your full name into the box below and your signature will be created and applied. By digitally signing below you confirm your identity is and that you supplied the answers above.

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