REFERENCE FORM

(To be completed by the Applicants Referees ONLY!)

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IMPORTANT READ ME

The person you have kindly offered to proved references for has applied to Support&Match CIC to become one of our VOLUNTEER HOMESHARER/GUARDIAN, and would be living in the home of an elderly, vulnerable and/or disabled person, providing between 10 and 15 hours per week of practical help, support and assistance under REGULAR HOMESHARE, or similarly 20 to 25 hours per week under HOMESHAREPLUS in exchange for affordable accommodation.

If the applicant is applying for GUARDIANSHIP with us then they will generally be providing up to 3 hours of companionship per week in exchange for affordable accommodation which is below the market value.

The purpose of the Homeshare project is to support and protect frail and vulnerable, elderly or disabled people who wish to stay in their own homes and keep their independence, and to also make affordable accommodation more accessible.

Guardianship differs from Homeshare in that it offers the applicant more flexibility and affordable accommodation.

To achieve this, we must confront the risk that a Homesharer could exploit this vulnerability, to the detriment of the person. The work that Support&Match CIC undertakes to vet all applicants is taken seriously, and our responsibility to the elderly, vulnerable and/or disabled people concerned is of significant importance.

We hope you can appreciate the reasons for our rigor in assessing the suitability of each Homeshare applicant, and why we stress the need for frankness.

Please note that by providing a reference for this Homeshare / Guardianship candidate you agree to allow Supportmatch Homeshare and/or Support&Match CIC to share the reference you provide with potential Householders looking for Homesharers or Guardians.

Thank you!

YOUR DETAILS (Referee)

REFEREES DETAILS

YOUR FULL NAME (Referee) (Required)

This is your name (Referee, not the name of the person you are providing references for).

YOUR EMAIL ADDRESS (Referee) (Required)

Email

Confirm Email

YOUR TELEPHONE NUMBER (Referee) (Required)

DETAILS OF THE PERSON YOU ARE WRITING REFERENCE FOR (Applicant)

DETAILS OF THE PERSON YOU A PROVIDING REFERENCE FOR

APPLICANTS FULL NAME (Required)

First

Last

This is not your name but the name of the person you are writing references for

BRIEFLY DESCRIBE HOW YOU KNOW THE APPLICANT (Required)

MONTHS (Required)

YEARS (Required)

WHAT WOULD YOU REGARD AS KEY STRENGTHS OF THE APPLICANT (Required)

WHAT WOULD YOU SAY WERE KEY WEAKNESSES OF THE APPLICANT (Required)

THEY YOUR APPLICANTS

This section gauges the strengths, weaknesses, abilities and general character of the Applicant.

Applicants willingness to take responsibility (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Thoughtfulness and consideration to others (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Trustworthiness (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Stable Personality (i.e. Positive - Not subject to adverse mood swings or other negative personality traits) (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Positive Outlook on Life (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Reliability (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Energy and Enthusiasm (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

Ability to be Positively Assertive and Proactive (Required)Select One Option PleaseOutstandingGoodAveragePoorVery PoorNo Comment

BASED ON YOUR KNOWLEDGE OF THE APPLICANT, DO YOU BELIEVE THEY ARE A SUITABLE CANDIDATE TO LIVE WITH AND SUPPORT AN ELDERLY PERSON AS A HOMESHARER OR GUARDIAN. (Required)

WHAT QUALITIES OR CHARACTERISTICS MAKE THE APPLICANT A SUITABLE CANDIDATE FOR A HOMESHARE OR GUARDIAN ROLE (Required)

ARE THERE ANY QUALITIES OR BEHAVIORS THAT MIGHT MAKE THE APPLICANT UNSUITABLE FOR THE HOMESHARER ROLE (Required)

PLEASE SHARE ANY ADDITIONAL COMMENTS OR OBSERVATIONS ABOUT THE APPLICANT’S SUITABILITY FOR THE HOMESHARER ROLE, SUCH AS THEIR RELIABILITY, INTERPERSONAL SKILLS, OR OTHER RELEVANT QUALITIES (Required)

ACKNOWLEDGMENT & AGREEMENT

AS THE REFEREE, I AUTHORISE SUPPORT&MATCH CIC AND SUPPORTMATCH HOMESHARE LTD TO USE THE INFORMATION I PROVIDE IN THIS REFERENCE FORM TO ASSESS AND SUPPORT THE APPLICANT’S APPLICATION FOR ENROLLMENT AS A HOMESHARER. I UNDERSTAND THAT MY INFORMATION WILL BE HANDLED IN LINE WITH SUPPORT&MATCH CIC AND SUPPORTMATCH HOMESHARE LTD’S DATA PROTECTION POLICIES AND APPLICABLE GDPR REGULATIONS.

I HEREBY (Required)

• AGREE
• DO NOT AGREE

IF YOU DO NOT AGREE, WE CANNOT USE YOUR REFERENCE OR SHARE YOUR FEEDBACK WITH A SUITABLE HOMEOWNER TO SUPPORT THE APPLICANT’S APPLICATION TO BECOME A HOMESHARER OR GUARDIAN

Privacy Notice: By submitting this form, you confirm that you understand Supportmatch will use the information provided to assess your enquiry or application, carry out suitability and safeguarding checks, arrange introductions where appropriate, prepare agreements, provide ongoing support, manage payments and comply with legal obligations.

Some information may be sensitive, including health, disability, safeguarding, identity or DBS-related information. We will only collect, use and share information where necessary, proportionate and lawful.

Please read our Supportmatch Group GDPR, Privacy and Data Protection Policy before submitting this form.

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