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Full name

Providing reference for

Relation to applicant

Company

Phone

Email

Association with applicant

How long have you known the applicant?

In what setting have you observed the applicants childcare skills?

The childcare position was:

Full time

Part time

Occational

The applicants level of responsibility was:

Full responsibility

Helper

The childcare was during:

The day

Evenings

Weekends

Overnight

The title of the applicants position

Start date of this position

How long did the applicant have this role? (if ongoing please say)

What was the age range the applicant provided care for?

Please describe in detail some of the applicants responsibilities and duties

How well does the applicant meet the critera for 'babysitter' and why?

To your knowledge, is there any reason the applicant should NOT work with children?

Yes (Please specify why in box)

No

If answered yes, please specify why

Any other comments?

I can confirm to my knowledge all the information provided is correct

Thanks for sharing your feedback with us!

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