Perform A Healthcare Reference Check

A healthcare professional who is being considered for potential employment with Freedom Healthcare Staffing has listed you as a professional reference. Freedom Healthcare Staffing respectfully asks your cooperation in completing the requested information. Please be assured that all information will be held confidential. Thank you for your assistance – it is greatly appreciated.

Name of Applicant*
First Last
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Position Title*
Is the job title of Registered Nurse correct?*
Hospital/Facility Name*
Did this applicant work for your facility?*
Did you supervise the applicant?*
Unit Worked*
Please rate the following competency as performed by the applicant:
Professional judgement:*
Quality of work:*
Clinical expertise:*
Professional appearance:*
Communication skills:*
Dependability:*
Attendence and punctuality:*
Flexibility:*
Comments
If you checked "Below Average Competency" for any of the above questions, please explain:
Would you rehire this healthcare professional?*
Completed By:
Name*
First Last
Phone*
Work Email*
Position Title*
Facility Name*
Facility City*
Facility State*
State
Would you like to learn about employment or staffing opportunities with Freedom Healthcare Staffing?
- Yes
Phone
This field is for validation purposes and should be left unchanged.

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Professional Reference Check

Please rate the following competency as performed by the applicant:

Completed By:

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