Childcare Reference Check Form

Candidate's Name

First

Last

Candidate's Job Title

Reference Name

First

Last

Reference Title/Position

Reference Email

Reference Phone

Relationship to Candidate

Length of Time Known

suitability children wish

Dates the Candidate Worked for you (if applicable)

Reason for Leaving (if applicable)

Please Describe the Candidate's Role & Responsibilities

Strengths of the Candidate

Areas for Improvement

Reliability/Dependability

Interpersonal Skills

Adaptability/Flexibility

Communication Skills

Initiative

Punctuality/Attendance

Any Red Flags or Concerns?

This position involves access to children in a private home setting. As an organisation committed to the welfare and protection of children, we wish to know if you are aware of any reason why this person might not be suitable to work with children.

Are you aware of any previous substantiated allegations, sanctions and/or disciplinary action taken against this person where there were concerns relating to children’s safety or protection?

Are you aware of any current or ongoing allegations or investigations, or of any disciplinary sanctions that remain against this person? This may or may not be related to children’s safety and protection.

Would you have any concerns about the applicants’ suitability for a role working with children?

Additional Comments