UConn Health Employee Reference Form Applicant Name:(Required) Position Title:(Required) Reference Provider Name/Title:(Required) Reference Provider Email Address:(Required) Company Representing & Contact Info:(Required) Applicant's Dates of Employment:(Required) Please verify the following information:Position Applicant Held: Relationship to Applicant: Supervisor/Manager/Direct Report Team Lead/Charge Nurse Co-Worker Educational None of the Above Please describe your relationship: Please answer the below questions:How long have you known the applicant?How does the applicant interact with peers and management?Has the applicant received satisfactory performance evaluations? Please put N/A if your role was not in direct supervision of the applicant.Why do you think this candidate would be a good fit for this position? Please comment on skills and abilities.What feedback would you provide this applicant in order for them to achieve optimum work performance?Please describe the applicant’s work ethic in regards to attendance and reliability.If given the opportunity, would you rehire this applicant? Yes No Consent By checking this box, I hereby attest that all information I have provided is true and complete.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.