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Professional Reference Check
A potential CORE Staffing employee has requested your participation in a professional reference check for them.
Please complete the questionnaire below to the best of your knowledge.
Thank you.
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* Indicates required question
Reference Name & Title (ex: Your Name, RN, Manager):
*
Your answer
Your contact information (Email & Phone Number):
*
Your answer
Name & Title of the candidate you are referring:
*
Your answer
Area/Department/Unit where you worked together:
*
Your answer
Name & location of the Facility where you worked with the candidate:
*
Your answer
Dates of employment that you worked together: (MM/YY)-(MM/YY)
*
Your answer
Quality of work:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Productivity:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Professionalism:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Flexibility:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Dependability:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Job Knowledge:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Leadership Ability:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Communication Skills:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Attendance/Punctuality:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Appearance:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Customer Service Skills:
*
Exceeds Expectations
Meets Expectations
Meets Some Expections
Does Not Meet Expectations
Reason Healthcare Professional left your facility:
*
Terminated
Lay-Off
Resigned
Temporary
Current Employee
N/A
Would you hire this Healthcare Professional again?
Yes
No
Clear selection
Any additional comments:
Your answer
Would you like to be contacted by a CORE Staffing Healthcare Recruiter?
*
Yes
No
Submit
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