CANDIDATE EVALUATION

We need you!

A candidate is applying for a position, here on our team, and we would appreciate a few moments of your time in filling out this form to help us evaluate this candidate’s ability. If you have any questions, comments or concerns, please feel free to contact the practice manager at 860.432.8400 or via email at pm@rheumspect.org

Candidate Name *
Candidate Name
(THE PERSON YOU ARE EVALUATING)
Evaluator Name *
Evaluator Name
(YOU)
Evaluator Phone Number
Evaluator Phone Number
(YOUR PHONE NUMBER)
What was the relationship between you and the candidate? *
Have you ever served in a supervisory role over the candidate? *
To the best of your knowledge, have there been any concerns and/or disciplinary actions (open or closed) in regards to him/her? does the candidate have any behavioral, physical or mental conditions that could affect his/her work? are there any issues with regard to substance abuse? *
SELECT ONE OPTION
Rate this candidate's success in his/her training *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Rate this candidate's work habits, including motivation and intiative *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Rate this candidate's communication with staff and patients *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Rate this candidate's communication during stressful situations *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Rate this candidate's ability to maintain patient confidentiality *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Rate this candidate's ability to demonstrate a high level of ethical standards *
On a scale of 1-5 (1 being POOR and 5 being EXCELLENT)
Hypothetically, would you (re)hire him/her? *

Thank you!

Rheumatology Specialists of CT thanks you for taking the time out of your schedule in filling out this form. We deeply appreciate your input!