Contact and Applicant Information
Clinical Faculty Name and Title
E-mail Address
(Remember: You must use the form your name@somesite.com)
Phone Number
Company or Institution
(Please make sure that your contact information is correct so that we many contact you if we have questions about your reference.)
Who is applying for this position?
In what clinical/classroom setting have you observed this student?
Applicant Rating
Please rate the applicant on a scale of 1 to 5, with 5 being the best. If you don't have information on any item, please choose "Not Applicable (NA)".
Overall Quality of Work	1 2 3 4 5 NA
Basic Nursing Skills	1 2 3 4 5 NA
Attention to Detail	1 2 3 4 5 NA
Customer Service Skills	1 2 3 4 5 NA
Attitude	1 2 3 4 5 NA
Leadership	1 2 3 4 5 NA
Critical Thinking Skills	1 2 3 4 5 NA
Energy	1 2 3 4 5 NA
Teamwork	1 2 3 4 5 NA
Collaboration	1 2 3 4 5 NA
Interpersonal Skills	1 2 3 4 5 NA
Integrity	1 2 3 4 5 NA
Dependability	1 2 3 4 5 NA
Appearance	1 2 3 4 5 NA
Overall Recommendation
To what degree would you recommend this applicant?
Recommend, Unconditionally Recommend, with some reservation Do not recommend
Please explain your choice

 

CAREERS

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East Tennessee Association of Healthcare Recruiters
280 Fort Sanders West Blvd. Bldg. 4, Suite 207,
Knoxville TN 37922
Tel: 865 531-5487 Fax: 865 531-5478

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