Aga Khan University Hospital (Nairobi)

EMPLOYEE REFERENCE FORM

Employee name; __________________________________________________________________

Name of Organization: __________________________________________________________________
Date of employment: __________________________________________________________________
Date of employment termination: __________________________________________________________________
Positions Held: __________________________________________________________________
Period: - __________________________________________________________________
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Please evaluate the above named employee on the listed qualities below and any other you may deem appropriate.
Please use the following assessment measurements;
Very good (VG), Good (G), Average (A), Poor (P), Not applicable (NA)
Quality Assessment Comments (if any)
Attendance/Punctuality
Professionalism at work
Willingness to perform assigned work
Ability to meet set deadlines
Quality of work
Ability to work in a team environment
Ability to work independently
Creativity/Initiative/ability to offer new ideas
Analytical thinking capabilities
Public relations/customer care skills
Honesty/ reliability and integrity
Enthusiasm for self development
Overall performance

Reasons for leaving: ___________________________________________________________________

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Please give any additional comments (e.g. would you recommend her/him for employment?)
________________________________________________________________________________________________________
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Name of Evaluator: ___________________________________ Title: _______________________________________
Signature: __________________________________________ Date: ______________________________________
Thank you for the evaluation. Please stamp the form with your official stamp or seal for authenticity.