Employment References Date* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Your Name:*Employee's Name:*What company did you have working experience?*Your Email:* Your Phone (in case we have additonal questions):*How do you know this person?*Current SupervisorCurrent Co-workerFormer SupervisorFormer Co-workerFriendRelativeWhen did you work with this person?*What were his/her job duties?*Did this person perform these duties competently?*YesNoHow was this person's attendance record?*If this person missed much work, what were the major reasons (i.e. illness, family issues; etc.)?Is this person punctual?Is this person dependable?Is this person honest/trustworthy?Is this person tactful?Does this person use good judgement?Is this person compassionate?Does this person show initiative?Is this person a "Team Player"?Does this person respect authority?Does this person need constant supervision?Can this person perform under pressure?Have you ever had any disciplinary issues with this person?*What do you feel this person's main strengths are?What do you feel this person's weaknesses are?This person has applied for a pediatric private duty nursing position, do you feel this person is suitable for it?*What was the reason this person left your employment?*Would you hire or work with this person in the future?*Do you have any other comments you would like to make?*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
