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Employment Reference Check #2

•Clinical references must provide dates of employment, give a rating of work history, state the position or specialty that the candidate worked. State the title of the person giving the references such as Charge RN, RN Supervisor, DON, and Nurse Manager. The reference MUST be someone who the candidate reported to directly on the floor unit. •
Applicant’s Name
Address
Supervisor’s Name
Untitled
MM slash DD slash YYYY

Employment History

The person above is applying for an employment with Agency Staffing and has listed you as previous employer. We would appreciate your assistance in verifying employment and evaluating job performance. All information will be treated with utmost confidentiality.
Is this employee eligible for rehire?
Personal Evaluation
Clinical Competency
Quality of Work
Quantity of Work
Attitude and Cooperation
Ability to get along with others
Adaptability to Work Situations
Dependability
Attendance and Punctuality
Personal Appearance
MM slash DD slash YYYY

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