Employment Review Applicant Name* First Last Healthcare Facility*Dates of EmploymentSupervisor Name and TitleLocation*Phone #*Name*Title*SupervisorDirectorCharge NurseCo-WorkerIs the employee eligible for rehire?*YesNoPlease rate the ProfessionalQuality of Work*ExcellentGoodAverageBelow AveragePoorAttitude / Cooperation*ExcellentGoodAverageBelow AveragePoorAbility to work with Others*ExcellentGoodAverageBelow AveragePoorDependability*ExcellentGoodAverageBelow AveragePoorPersonal Appearance*ExcellentGoodAverageBelow AveragePoorAttendance / Punctuality*ExcellentGoodAverageBelow AveragePoorWork Ethic*ExcellentGoodAverageBelow AveragePoorPatient Care*ExcellentGoodAverageBelow AveragePoorComments: