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Reference Check for Keta Medical Center

Candidate Name

Please confirm: I am a current or former co-worker of the individual named above and can provide accurate information as a professional reference.
Yes
No

Your Information

Questions about your experience with the candidate:

What is your relationship with the candidate (select all that apply)

Please rate the candidate on a scale of 1-5, where 5 is excellent and 1 is poor.

In relation to their position

In relation to their position (For example, if the candidate is a nurse, their ability to administer IVs)

Here are some helpful things to consider, but feel free to use your own words. A leader takes initiative, a quiet contributor works independently, and a team player collaborates well. Someone who balances leadership and support knows when to step up or follow. A team builder fosters collaboration, a solutions-oriented person solves problems, an influencer impacts decisions, and a goal-driven contributor stays focused on results.


 These could be technical, professional, or another aspect of their work. We know this can be a tough question, so it may help to think of it as friendly, professional advice you would give a colleague or employee. Consider what they could work on to become an even stronger clinician or professional.

Would you recommend the candidate for a position?
Yes
No
To the best of your knowledge, does the candidate remain in good standing in your organization?
Yes
No
To the best of your knowledge, is there anything—personally or professionally—that could impact the candidate’s ability to perform their job?
Yes
No
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