Reference Release

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

Is this individual eligible for rehire?