INTERVIEW EVALUATION FORM

Candidate Name : IRVINDA

Appliying for position of PARAMEDIC MEDICAL SERVICE MPI Department : MEDICAL SERVICE
Interviewer's Name : dr Felicia Setiawan, MKK Interviewer's Department : MEDICAL SERVICE
Please ask the questions representing STAR (Situation, Task/Action, Result): What situation they had faced, the task that was assigned to them, action that they actually did and the result of their
action.
Put √ in the box which represent the candidate adequately based on your evaluation
I. Technical Knowledge & Skills Score
1 2 3 4
Poor Good

□ Seems exceptionally well qualified for this type of work in terms of knowledge and skills Explanation :
P Has knowledge & skills that are very relevant to this type of work Technical knowledge for emergency medicine and general 8/10
□ Appears to have some knowledge & skills that could be of benefit to this type of work
□ Does not appear to have any knowledge or skills that are related to this type of work
II. Achievement Patterns Score
1 2 3 4
Poor Good

□ Seems to be highly determined individual who has accomplised many things. Explanation :
P Has shown determination and accomplishment in a number of ways Humbly acknowledge previous failure and display determination to learn
□ Demonstrates slight evidence of determination and accomplisment more.
□ Does not appear to have any record of determination or accomplisment
III. Interpersonal Communication Skills Score
1 2 3 4
Poor Good

□ Manifested very high degree of interpersonal communication skills Explanation :

P Seemed quite effective in terms of interpersonal communication skills Able to develop rapport quite immediately
□ Seemed somewhat ineffective in terms of interpersonal communication skills
□ Manifested a very low level interpersonal communication skills
IV. Self Confidence Score
1 2 3 4
Poor Good

□ Seems realistically confident in this his / her ability to do the job Explanation :
□ Seems overly self assured & confident in his/her ability to do the job confidence medium
P Seems somewhat unsure of his / her ability to do this job
□ Confidence in his / her ability is lacking
V. Career Goals Score
1 2 3 4
Poor Good

□ Careers posibilities are very realistic and Candidate would be very Explanation :
satisfied with this type of work previously worked as Nurse in Hospital for 2 year and Lab Clinic. Familiar
P Careers posibilities are realistic and Candidate would be generally with all primary health care medical treatment and data entry for large
satisfied with this type of work number of patient
□ Careers posibilities are slight unrealistic and Candidate might be
dissatisfied with this type of work
□ Careers posibilities are unrealistic and Candidate would be unhappy
with this type of work
VI. Work / Extra Curricular Experience Score
1 2 3 4
Poor Good

□ Candidate has extensive experience that is directly related to the position Explanation :
P Candidate has some experience that could be directly applied to the position No related Extra Curricular exp
□ Candidate has experience that is indirectly related to the position
□ Candidate has no experince that could be applied to the position
VII. Potential Leader Development Score
1 2 3 4
Poor Good

□ Candidate has proven leadership skill Explanation :

□ Candidate has shown potential for leadership position Candidate is displaying strong confidence during interview but can be
P Candidate can be developed to be a leader by additional effort unsure to make difficult decision
□ Candidate will be agood individual contributor
VII. Does he/she has any relatives with Medco employee/Medco contractor employee/government official? None stated during interview
(Please describe the details: name of relatives, position/institution, and company)
Government Officials include individuals who hold official government position (legislative, executive, administrative or
judicial); individuals who exercise public functions for or on behalf of a country or a public agency/ enterprise; officers,
employees, or agents of any government, government agency, or government instrumentally including government-
owned or government-controlled companies; officials and agents of political parties; candidates for political office; close
relatives of any of the above.
Note : as a user, you need to confirm will such involvement effect the hiring process or Medco business in the future
(user needs to fill in Internship Declaration and Approval Form).

VIII. Interview Summary:

Recommended for the position

Recommendation

Exceptional Superior P Good Average/Marginal Unacceptable

Proceed Stop

Interviewer's Signature : Date :

03-Sep-21