Employment Review Applicant Name* First Last Healthcare Facility* Dates of Employment HiddenSupervisor Name and Title Location* Phone #*Name* Title*SupervisorDirectorCharge NurseCo-WorkerHiddenIs the employee eligible for rehire?* Yes No HiddenPlease rate the ProfessionalQuality of Work* Excellent Good Average Below Average Poor Attitude / Cooperation* Excellent Good Average Below Average Poor Ability to work with Others* Excellent Good Average Below Average Poor Dependability* Excellent Good Average Below Average Poor Personal Appearance* Excellent Good Average Below Average Poor Attendance / Punctuality* Excellent Good Average Below Average Poor Work Ethic* Excellent Good Average Below Average Poor Patient Care* Excellent Good Average Below Average Poor Comments: