HiddenNext Steps: Install the Survey Add-OnThis form requires the Gravity Forms Survey Add-On. Important: Delete this tip before you publish the form.Please fill out the information below with your information.Reference Name(Required) First Last Facility Name(Required) Reference Title(Required) Email(Required) Phone(Required)Please fill out the information below as it pertains to the candidate the reference is being given for.Candidate Name(Required) First Last Unit Candidate Worked On(Required) Candidate Title(Required) Dates of Candidate Employment(Required) Is Candidate Eligible for Rehire?(Required)YesNoPlease select one value for each item belowAttendance & Punctuality(Required) Excellent Above Average Average Below Average Poor Clinical Skills/Job Knowledge(Required) Excellent Above Average Average Below Average Poor Motivation(Required) Excellent Above Average Average Below Average Poor Communication(Required) Excellent Above Average Average Below Average Poor Cooperation(Required) Excellent Above Average Average Below Average Poor Critical Thinking Skills(Required) Excellent Above Average Average Below Average Poor Ability to Prioritize(Required) Excellent Above Average Average Below Average Poor Quality of Work(Required) Excellent Above Average Average Below Average Poor Initiative(Required) Excellent Above Average Average Below Average Poor Willingness to Accept Supervision(Required) Excellent Above Average Average Below Average Poor Interest & Enthusiasm(Required) Excellent Above Average Average Below Average Poor Flexibility & Adaptability(Required) Excellent Above Average Average Below Average Poor Team Player(Required) Excellent Above Average Average Below Average Poor Candidate's areas of strength:Would you endorse this Candidate? (Please Explain)How would you describe their customer service/bedside manner?How would you describe their personality?Additional Comments Δ 614-389-2571 5890 Venture Drive Dublin, Ohio 43017
