Employee Reference - Nurse / Caregiver

Employment Reference - Nurse / Caregiver

We appreciate that your time is limited and offer our thanks, on the behalf of the candidate, for completing this Employment Reference - Nurse / Caregiver, to provide insight into the quality of the candidate and his / her suitability for a role here in Bermuda. Your responses will be held in strict confidence and will not be shared with the candidate at all. This professional reference will take 10 mins to complete.

If you have any questions, please send an email to Barbara R. Tannock, Director at: btannock@catalyst.bm.

Thank you again for your time.

I / We are submitting a reference for: *

Candidate's Job Category: *

Registered / Licensed Nurse

Non Registered / Non Licensed Nurse

Caregiver - Elder

Caregiver - Child(ren)

Today's Date:*

What is your name? Person completing this Employment Reference. *

Where do you currently work? And what is your current role?

Where did you work with this Applicant? / how do you know the applicant?

I submit in this capacity: (Choose all that apply)

Professional Capacity - Former Direct Supervisor

Professional Capacity - Current Direct Supervisor

Personal, he / she is family / friend.

Our relationship spanned 0 - 2 years

Our relationship spanned 2 - 5 years

Our relationship spanned 5 - 10 years

Clinical Competency (Check one):

5 - Exceptionally well qualified - consistently exceeded the clinical requirements of the role.

4 - Above average clinical competency.

3 - Average level of competency for the role

2 - Below average clinical competency for the role

1 - Significantly below the expected clinical competency required given training & experience.

Initiative

5. A self starter, seeks additional tasks

4. Resourceful

3, Routine Worker - requires supervision on new tasks

2. Frequent Supervision is Required

1. Requires detailed instruction. Heavily dependent on others

Organization

5. Prioritizes and accomplishes tasks independently

4. Organizes work and accomplishes tasks with minimal direction

3. Reorganizes efficient ways of accomplishing tasks with some direction

2.Variable efficiency in managing tasks

1. Unable to prioritize tasks, disorganized work habits

Communication

5. Clear expression of ideas even under stress

4. Communicates clearly under unusual circumstances

3. Communicates clearly under usual circumstances

2. Acceptable communication under normal circumstances

1. Has difficulty communicating ideas and intentions to others.

Option 2

Judgement

5. Consistently demonstrates local / sound judgement

4. Thinks clearly and positively under unusual conditions

3. Good judgement on routine matters

2. Fair judgement under normal circumstances, sometimes acts before thinking.

1. Poor judgement / likely to make illogical decisions

Adaptability / Flexibility:

5. Highly flexible; can handle many varied and competing assignments

4. Usually learns new assignments with normal supervision

3. Average amount of guidance needed to learn variety of duties

2. Has some difficult when shift to new / different assignments

1. Has considerable difficulty in adjusting to new assignments

Dependability:

5. Merits utmost confidence

4. Usually meets responsibilities carefully and correctly.

3. Usually can be depended upon, but more guidance needed on important matters

2. Somewhat unreliable, requires occasional check on routine tasks

1. Unreliable, needs detailed supervision and follow up.

Grooming (Personal, Hygiene, Uniform):

5. Consistently well groomed and observes an exceptional hygiene standard

4. Above average presentation and hygiene standard

3. Average grooming and hygiene standard

2. Poor grooming and hygiene standard

1. Unacceptably poor grooming and hygiene standard

This candidate gets along well with others. *

Applicant handles stressful situations well. *

I believe the applicant is honest and trustworthy. *

I have trust the applicant would keep private information confidential. *

I have not witnessed any displays of discrimination in his / her delivery of care. *

I do not have knowledge of the candidate's use or involvement with illicit drugs or narcotics. *

Strengths:

Weaknesses:

Community:

English Fluency: Please assess the candidate's command of the English Language.

Absolute - English is her / his native tongue. Good written and oral.

Very Good - English is second language, but above average written and oral fluency.

Good to Average

Below Average

Poor - Had a difficult time communicating with leaders, colleagues and patients.

Would you re-hire this candidate? Please explain your answer.

Is there anything else that you would like to share with us as we consider this application?

What is your best contact number?

What is your Email Address?*