Reference Form

The below named person has expressed an interest in becoming a member of Dudley safeguarding in schools sports standard and has given your name as a referee. The membership involves substantial access to and responsibility for children through the delivery of sport in schools. 

 

As a scheme committed to the welfare and protection of children, we wish to know if there is any reason at all to be concerned about this applicant’s suitability for this type of membership.

 

If you are happy to complete this reference, any information will be treated confidentially and in accordance with relevant legislation and guidance.  Information will only be shared with the person conducting the assessment of the candidate's suitability for the membership, if he/she is granted membership.  We would appreciate you being open and honest in your evaluation of this person.

About the person you are supplying a reference for.
1.
Name of candidate:
Required
2.
How long have you known this person?
Required
3.
In what capacity? (NB references cannot be accepted from family or friends)
Required
4.
Please comment on the above named person’s suitability to work with children and young people?
Required
5.
Please rate this person on the following – please select one option for each statement
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Responsibility
Maturity
Self-motivation
Ability to motivate others
Trustworthiness
Reliability
6.
Do you agree to this reference being shared with applicant?
Required
7.
This membership involves substantial access to children. As a scheme committed to the welfare and protection of children, we wish to know if have any concerns about the applicants’ suitability for this membership. Do you have any concerns of a safeguarding nature concerning this applicant? (If you answer YES, we will contact you by telephone in confidence)
Required
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About the person you are supplying a reference for.

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