To provide our clients with the highest quality of candidates available, we must find the best. In an attempt to do so, we are requesting your assistance in providing a reference. Please complete the form below to the best of your knowledge. Step 1 of 2 50% Candidate Name*The name of the person for whom you are completing the reference. First Last Reference InformationReference NameThe name of the individual completing the reference form on candidate's behalf. First Last TitleOrganizationEmail Phone1. How long have you known them and in what capacity have you worked together?2. On a scale of 1-10, how would you describe his or her's clinical judgment and skills?Please enter a number from 1 to 10.2a. Please describe the reason for your rating.3. On a scale of 1-10, how would you rate his/her knowledge fundamentals?Please enter a number from 1 to 10.3a. Please describe the reason for your rating.4. How well do they know their limitations?5. How would you describe their personality and temperament?6. How would you describe their work ethic?7. Do they present a professional appearance?8. What are their greatest strengths?9. How do they handle constructive criticism and/or stressful situations?10. How would you assess their rapport with patients and their families? 11. How do they get along with his/her colleagues and support staff?12. To your knowledge, have they been named in any malpractice suits?13. To your knowledge, have they had any hospital privilege issues?14. To your knowledge, have they had any issues with punctuality?15. Are you aware of any arrests or convictions relating to alcohol or drug abuse?16. Have they had any trouble meeting any job requirements?17. If you were recruiting, is this someone you would consider hiring and why?18. Would you refer a family member or friend to them for medical care? If not, why?19. Any additional thoughts you would like to add?
