Registered Nurse

Reference Check

Applicant Name:

Title at SCH:

Please provide us with 3 of your former supervisors/managers. Be sure to write emails and phone numbers clearly as we will be reaching out to at least one of these people for your reference. Please let them know to expect a call from your business partner at SCH. Reference Name:

Company Name:

Relationship:

Phone number:

Email:

Reference Name:

Company Name:

Relationship

Phone number:

Email:

Reference Name:

Company Name:

Relationship

Phone number:

Email:

I give my authorization for these references and that the person has been notified. Applicant Initials

These are some of the questions we will ask when we call your reference: 1) Please describe your reporting relationship with the applicant. If none, in what capacity did you observe the applicant’s work?

2) What is your understanding of the applicant’s reason for looking for other job opportunities? 3) Describe the applicant’s work ethic:

4) How does the applicant handle stress on the job? What was the cause of the stress? 5) How does the applicant work with a team? Was there ever a time when they did not work well with others? 6) Describe the applicant’s reliability:

7) What is the applicant’s significant strengths?

8) What is your overall assessment of the applicant in this role? 9) We are considering the applicant for a position as a . Would you recommend him/her for this position? Why or why not?

10) Are there any additional comments you would like to make? Thank you for your assistance!

Reference Completed By:

Angelique Vargas

Westerly Health Center

Charge Nurse

401-***-****

Randy Rauso

BHG

Program Director

401-***-****

*****.*****@***********.***

Michelle Raleigh

Benchmark

Charge Nurse

401-***-****

********@****************.***

HA

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