Bluestones Medical

Bluestones Medical Reference Form


Candidate information

Candidate name
Job title/band
Place of work
Ward / department
Dates of employment  
Reason(s) for leaving (if applicable)

Candidate rating

Reliability
Professional attitude/standards
Clinical skills/abilities
Patient handling
Ability to work as part of a team

 

Does the candidate have any recent or ongoing disciplinary action or referrals:
If yes, please provide details:

 

Additional comments

Referee information

Referee name
Referee email address
Referee position

When you digitally sign and submit this form, a PDF copy will be sent to Bluestones Medical and a copy sent to you for your records.

Leave this empty:

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Signature Certificate
Document name: Bluestones Medical Reference Form
lock iconUnique Document ID: 32b228f9a16179e7c5268221b7ada5c00faf2b99
Timestamp Audit
12th June 2019 4:24 pm BSTBluestones Medical Reference Form Uploaded by Bluestones Medical - info@bluestonesmedical.co.uk IP 81.141.39.144
13th June 2019 8:56 am BSTMatt Cody TEST - mattcodyapex+medtest@gmail.com added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
13th June 2019 9:03 am BSTTracy Lumb - tracy.lumb@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
13th June 2019 9:04 am BSTTracy Lumb - tracy@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
14th August 2019 3:19 pm BSTNatalie O'brien - Natalie.Obrien@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
16th August 2019 2:53 pm BSTNatalie O'brien - Natalie.Obrien@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
2nd September 2019 9:18 am BSTMedical References - references@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
19th September 2019 3:19 pm BSTMedical References - references@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 51.52.5.18
15th March 2021 11:56 am BSTMedical References - references@bluestonesmedical.co.uk added by Bluestones Medical - info@bluestonesmedical.co.uk as a CC'd Recipient Ip: 81.141.39.144