Therapist Reference Form

We appreciate you taking the time to complete this reference form. If you have further questions, and/or would like to speak with us directly, please email us at: hiring@natachapennycooke.com

Name

First Name

Last Name

Name of Candidate

Phone

(###)

###

####

What was your professional relationship to the candidate?

How long have you known the candidate?

What job did the candidate perform and what was their responsibilities?

What were the candidate’s strong points?

What were the candidate’s weaknesses?

How did the candidate react to pressure and/or deadlines?

How did the candidate get along with peers, supervisors and colleagues. Overall, how do you rate his/her interpersonal skills on a scale of 1-5 (5 being highest)?

What areas of improvement would you say should be addressed in the candidate’s next position?

If the appropriate position were available within your organization, would you rehire the candidate? If not, why not?

On a scale, how you rate them on the following: Has emotional intelligence skills

On a scale, how you rate them on the following: Has a good work ethic

On a scale, how you rate them on the following: Takes Initiative

On a scale, how you rate them on the following: Is punctual and has regular attendance

On a scale, how you rate them on the following: Has excellent communication skills

On a scale, how you rate them on the following: Has excellent customer service, i.e., working with clients

On a scale, how you rate them on the following: Has leadership skills

On a scale, how you rate them on the following: Has excellent professional skills, i.e., time management, organization, etc.

On a scale, how you rate them on the following: Has conflict resolution skills, i.e., ability to manage difficulties as they arose

On a scale, how you rate them on the following: Excelled in their performance duties related to the specific employment

Is there any other information you would like to add or any pertinent issues regarding the candidate’s performance that we have not covered?

Therapist Reference Form

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