Business Reference
REFERENCE REQUEST FOR
*
Your Name & Position
Company Name & Address where worked with candidate
Relationship with candidate
Email
Phone number
Employment Details
Date Employed From
/
Month
/
Day
Year
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Date Employed To
/
Month
/
Day
Year
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Candidates Job Title
Reason For Leaving
Attendance
Excellent
Good
Average
Poor
Quality of Work
Excellent
Good
Average
Poor
Job Knowledge
Excellent
Good
Average
Poor
Cooperation
Excellent
Good
Average
Poor
Dependability
Excellent
Good
Average
Poor
Appearance
Excellent
Good
Average
Poor
Stability
Excellent
Good
Average
Poor
Overall Rating
Excellent
Good
Average
Poor
Comments:
Reviewed by NCHS RN: ___________________________________________
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