Academic Reference Please complete the following academic mentor reference for the candidate. All fields marked with * are required. 1. Candidate Details Candidate Name * How long have you known the candidate? * In what capacity do you know the candidate? * Please select...Academic MentorTutorLecturerTeacherCourse LeaderPlacement SupervisorOther If Other, please specify: 2. Conduct & Suitability To the best of your knowledge, was the candidate subject to any disciplinary proceedings, formal investigation or other concern relating to their conduct or suitability during the period you knew them? * Please select...YesNo Are you aware of any disciplinary action, safeguarding concern, allegation, investigation or other matter relating to the safety or welfare of children or vulnerable people? * Please select...YesNo Do you know of any reason why the candidate may be unsuitable to work with children or young people? * Please select...YesNo Are you aware of any reason why the candidate should not be employed in a role involving contact with children or young people? * Please select...YesNo If you have answered Yes to any of the safeguarding or suitability questions above, please provide full details. If you have answered No to all questions, please enter "N/A". * Based on your knowledge of the candidate, do you have any concerns about their suitability to work in a school or educational environment? * Please select...No concernsYes - please provide details If Yes, please provide details. If No, please enter "N/A". * 3. Candidate Assessment Please rate the candidate based on your experience of knowing, teaching or mentoring them. Honesty and Integrity * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Attendance, Punctuality and Reliability * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Professional and Personal Conduct * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Communication Skills * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Commitment and Motivation * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Adaptability and Flexibility * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Suitability to Work with Children and Young People * Please select a rating...ExcellentGoodAverageBelow AveragePoorNot Applicable Additional Comments 4. Referee Details Your Name * Your Position * Educational Institution / Organisation * Organisation Telephone Number * Organisation Address * Your Professional / Work Email Address * Today's Date * 6. Declaration & Confirmation Are you authorised to provide this reference in your professional capacity? * Please select...YesNo I confirm that the information provided in this reference is true and accurate to the best of my knowledge. I understand that this reference may be used by the candidate's prospective employer for recruitment and safeguarding purposes. * I confirm the above statement Sign Below * Please sign in the box above to confirm that the information provided is accurate to the best of your knowledge and that you are providing this reference in your professional capacity.
