Employment Review Applicant Name* First Last Healthcare Facility*Dates of EmploymentLocation*Supervisor Name and Title*Phone #*Is 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: