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Employment Reference - Nurse / Caregiver

We appreciate that your time is limited and offer our thanks, on the behalf of the candidate, for completing this Employment Reference - Nurse / Caregiver, to provide insight into the quality of the candidate and his / her suitability for a role here in Bermuda. Your responses will be held in strict confidence and will not be shared with the candidate at all.  This professional reference will take 10 mins to complete. 

If you have any questions, please send an email to Barbara R. Tannock, Director at:

Thank you again for your time. 

I / We are submitting a reference for: *

Candidate's Job Category: *

Today's Date:*

What is your name? Person completing this Employment Reference. *

Where do you currently work? And what is your current role?

Where did you work with this Applicant? / how do you know the applicant?

I submit in this capacity: (Choose all that apply)

Clinical Competency (Check one):





Adaptability / Flexibility:


Grooming (Personal, Hygiene, Uniform):

This candidate gets along well with others. *

Select an option

Applicant handles stressful situations well. *

Select an option

I believe the applicant is honest and trustworthy. *

Select an option

I have trust the applicant would keep private information confidential. *

Select an option

I have not witnessed any displays of discrimination in his / her delivery of care. *

Select an option

I do not have knowledge of the candidate's use or involvement with illicit drugs or narcotics. *

Select an option




English Fluency: Please assess the candidate's command of the English Language.

Would you re-hire this candidate? Please explain your answer.

Is there anything else that you would like to share with us as we consider this application?

What is your best contact number?

What is your Email Address?*


Bermuda / BOTC Passport Questionnaire 


Please answer all questions as we prepare your digital BOTC passport application.

What type of passport are you applying for?*

Please check which applies*

Who is this passport for?*


First and middle names*

Maiden or all previous names

Current Address*



Date of birth*


Town of birth*

Country of birth*

Mobile Phone Number*

Alternative Phone Number

Email Address*

Has the person named had any sort of passport (British or Otherwise) or been included in any passport before?*

If yes, please state passport number(s)

Details of lost or stolen passport

Issued at

In year

Holders surname at the time it was issued

First and middle names

How the passport was lost, or why it is not available

Date of loss

Place of loss

Mother's full name*

Town and country of birth*

Date of birth*

Nationality and citizenship at the time of applicant's birth*

If they have a British Overseas Territories passport give the number

Date of issue

Date of issue

Father's full name*

Town and Country of birth*

Date of birth*

Nationality and citizenship at the time of applicant's birth*

If they have a British Overseas Territories passport give the number

Has the applicant been granted a certificate of registration or naturalization?*

If yes, give date of issue, Certificate number and place of issue

Countersignatury's Full Name

Countersignatory's Email address

How long have they known you, and under what capacity?

Countersignatory's employer and the address they work at


Mobile Phone number

Alternative phone number

Current Passport number

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