Employment Reference

Reference (Your) Name:

Position:
Organization:

Name of Applicant:
Applicant's position: Full Time Part Time Casual
Length of relationship: Have you supervised this individual? (Y/N)

Work Quality
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Organizational/Time Management Skills

Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Initiative
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Job Knowledge
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Customer Service Skills

Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Team Player
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Verbal Communication
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable
Written Communication (Reporting, charting, etc.)
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Computer/Technical Skills
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Problem Solving/Critical Thinking Skills

Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Flexibility
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Attendance/Punctuality
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Safety Awareness
Very Good/ Not Comments:
Excellent Poor
Good Average Applicable

Comments for other areas specific to the applicant:

If you were in a position to rehire this individual, would you do so? Yes No Maybe
If No/Maybe, please elaborate:

Thank you for taking the time to fill out this form
Carewest use only
Recruiter: Tari Campbell-Hope Date:
Site: Comp. #