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  • Referee Details

  • Applicant Details

  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • SECTION 1 - HOW WOULD YOU ASSESS THE FOLLOWING?

    Please tick the relevant boxes Excellent, Good, Average, Poor
  • SECTION - 2 Please answer the following questions

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  • PLEASE CONFIRM:

    I can confirm that all the details provided are accurate at the time that this reference was completed. I can confirm that I am authorised to provide a reference on behalf of my organisation. I understand this reference may be shown to a third party for auditing purposes and I can confirm that Maxahealth and this organisation has consent and authorisation to disclose the contents of this reference to its end user, hirer clients. I understand that the applicant has the legal right to request a copy of their reference.
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