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 presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentCoping*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentCommitment to Task*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentConflict Management*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentProblem-Solving*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentOrganization and Planning*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentGrooming*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentPunctuality*Very strong evidence skill is presentStrong evidence skill is presentSome evidence skill is presentInsufficient evidence for or against skillStrong evidence skill is not presentWould you recommend this person for the nursing program?*YesNoAdditional CommentsDate* Date Format: MM slash DD slash YYYY Name* First Last Phone Number*Email Address* TitleHIDDEN - Applicant Email
