I grant permission to the Employer listed above to release information to Medical Staffing Partners regarding my performance while employed at the above facility. I understand that a photocopy of this authorization would be accepted with the same authority as the original.
Please rate the following attributes by checking the appropriate box below.
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Adaptability to Environment
Attendance/Punctuality
Attitude
Dependability
Professionalism
Quality of Work
Quantity of Work
Team Player
Excellent
Above Average
Satisfactory
Below Average
Poor