Applications Nursing Reference Questionnaire Nursing Applicant Reference Questionnaire The applicant has chosen this to be a confidential reference. An honest and complete opinion will be most helpful. The applicant has chosen this to be a non-confidential reference. An honest and complete opinion will be most helpful. This reference form is associated with the following Nursing program applicant. If this is incorrect, please update the first and last name of the applicant here.* First Last How long have you known this individual and in what capacity?*From your experience with this individual please rate him/her in the following areas as they pertain to the practice of nursing.Communication* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Coping* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Commitment to Task* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Conflict Management* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Problem-Solving* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Organization and Planning* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Grooming* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Punctuality* Very strong evidence skill is present Strong evidence skill is present Some evidence skill is present Insufficient evidence for or against skill Strong evidence skill is not present Would you recommend this person for the nursing program?* Yes No Additional CommentsDate* MM slash DD slash YYYY Name* First Last Phone Number*Email Address* TitleThis field is hidden when viewing the formHIDDEN - Applicant Email
