Reference for an Applicant for Peer Supporter Training

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for agreeing to provide a reference for this applicant to become a breastfeeding peer supporter. Treasure Chest is an organisation that aims to promote, support and encourage breastfeeding in the York area. As part of the application process we ask each applicant to provide two references. References must attest to the applicant’s suitability for the role of supporting a breastfeeding mother and to the applicant’s character.

We will hold your personal data in case we need to contact you, for no longer than one year.

Applicant's name *

Referee's name *

Referee's address *

Referee's telephone number *

Referee's email address *

How long have you known the applicant and in what capacity? *

Have you personally observed the applicant in interactions with other mothers and babies? *

Yes

Please give details: *

Is the applicant: *

Usually

Very often

Sometimes

Rarely

Never

Friendly?

Reliable?

Easy to talk to?

Honest?

Good listener?

Empathetic?

Supportive?

Non-judgemental?

Please give some further information about the candidate. You may like to mention skills such as empathy, commitment, interactions with others, supportiveness, or anything else that you feel to be relevant: *

If you have any reservations, or if you have any other information you would like us to know about the applicant, please tell us:

Please confirm that, to the best of your knowledge, the information you have provided to us is complete and accurate: *

Yes

Many thanks for taking the time to provide us with a reference. Please now click 'submit' below. If you wish to contact us please email applications@treasurechest.org.uk

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms