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  • Reference Check Form Final March 2010

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    Pola Busalpa
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    The reference check form from Rosario Busalpa, a nurse supervisor at Valleyview Care Centre, provides an above average review of Mico Sy's job performance, communication skills, interpersonal skills, personal qualities, attendance, and reason for leaving their previous position as a nurse. Busalpa marked that they would rehire Mico Sy for the health care aid position they have applied for.

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    Format for Reference checklist

    Original Title

    Reference Check Form Final March 2010[1]

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    The reference check form from Rosario Busalpa, a nurse supervisor at Valleyview Care Centre, provides an above average review of Mico Sy's job performance, communication skills, interpersonal skills, personal qualities, attendance, and reason for leaving their previous position as a nurse. Busalpa marked that they would rehire Mico Sy for the health care aid position they have applied for.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    17 views2 pages

    Reference Check Form Final March 2010

    Uploaded by

    Pola Busalpa
    The reference check form from Rosario Busalpa, a nurse supervisor at Valleyview Care Centre, provides an above average review of Mico Sy's job performance, communication skills, interpersonal skills, personal qualities, attendance, and reason for leaving their previous position as a nurse. Busalpa marked that they would rehire Mico Sy for the health care aid position they have applied for.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Valleyview Care Centre, Brandon

    REFERENCE CHECK FORM


    Date: ____May 15, 2015
    Name of Person Providing Reference: Rosario Busalpa
    Job Title/Position: Nurse V - Supervisor

    Name of Applicant: Mico Sy

    Position applied for: Health care aid position

    Present/previous position: Nurse 3

    Dates of employment from: 2011 to: Dec. 2014

    Please "" appropriate area:


    A. Job Performance:

    Poor

    Fair

    Average

    Above Average

    Quality of Work

    Quantity of Work

    Job knowledge

    Initiative

    Decision Making

    Planning/organization

    Leadership

    B. Communication Skills:

    Poor

    Fair

    Average

    Above Average

    Oral

    Written

    With Residents

    With Co-Workers

    C. Interpersonal Skills:

    Poor

    Fair

    Average

    Above Average

    Ability to work with


    others

    Ability to work independently

    Team Ability

    Ability to follow instructions


    Complete Assignments

    D. Personal Qualities:
    Attitude
    Creative
    Adaptability/Flexibility
    E. Attendance:
    Punctuality
    Notifies unit
    regarding absenteeism
    Number of absent shifts
    in past year.

    Poor

    Fair

    Average

    Poor

    Fair

    Average

    Above Average

    Above Average

    F. Reason for Leaving Employment: _For greener pasture _______________________________________


    _________________________________________________________________________________________
    _________________________________________________________________________________________
    _________________________________________________________________________________________
    _________________________________________________________________________________________
    Additional Comments:

    _________________________________________________________________________________________
    ________________________________________________________________________________________

    Would you rehire employee?


    Yes or No

    Office Use:
    If Reference completed verbally/via phone, complete information below:
    Name :

    Date: :

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