Reference Reference Reference Birth Date MM slash DD slash YYYY DateCandidate's Name whom this reference is for:(Required) First Name Last Name What was their position or title? Company/Organization's Name: City and State: Date Employment Started: MM slash DD slash YYYY Start date: Month/YearDate Employment Ended: MM slash DD slash YYYY End date: Month/YearReason for leaving? Would you rehire this individual? Yes No Not Sure Your Full Name Please(Required) First Name Last Name Your Phone Number:Please enter a valid phone number.Your relationship to candidate: Supervisor Co-worker Academic Other Clinical Assessment AttendancePlease SelectExcellentGoodSatisfactoryUnsatisfactoryShows up on time every timeClinical PerformancePlease SelectExcellentGoodSatisfactoryUnsatisfactoryCandidates ability to make clear sound and proactive decisions reflecting good clinical skills/judgmentPatient and Customer FocusedPlease SelectExcellentGoodSatisfactoryUnsatisfactoryDemonstration of customer/people service/patient careTeamwork and CollaborationPlease SelectExcellentGoodSatisfactoryUnsatisfactoryShows respect for the contribution of others, communicates with patient, family, and team members clearly and concisely. Effective CommunicationPlease SelectExcellentGoodSatisfactoryUnsatisfactoryArticulate, can relate to all levels/listen & handle difficult people/conflict Planning and OrganizationPlease SelectExcellentGoodSatisfactoryUnsatisfactoryAbility to assess, plan and prioritize care for more than one patient DocumentationPlease SelectExcellentGoodSatisfactoryUnsatisfactoryRecords all aspects of patient status accurately and timely Professional Assessment TrustworthinessPlease SelectExcellentGoodSatisfactoryUnsatisfactoryDependabilityPlease SelectExcellentGoodSatisfactoryUnsatisfactoryShows initiativePlease SelectExcellentGoodSatisfactoryUnsatisfactoryWork HabitsPlease SelectExcellentGoodSatisfactoryUnsatisfactoryFlexibilityPlease SelectExcellentGoodSatisfactoryUnsatisfactoryFollows procedures wellPlease SelectExcellentGoodSatisfactoryUnsatisfactoryReliabilityPlease SelectExcellentGoodSatisfactoryUnsatisfactoryFast LearnerPlease SelectExcellentGoodSatisfactoryUnsatisfactoryPlease add any extra details or testimonies about candidate: Please add any extra details or testimonies about candidate: