Reference Form

NOTE TO RECOMMENDER: You have been requested to complete this reference form by a applicant applying for a summer internship, management residency, or administrative fellowship at Loma Linda University Health. Your honest appraisal is very valuable to us and will assist us in evaluating the applicant's qualifications for one of our talent development programs. Please complete the following reference form and email directly to Loma Linda University Health - Human Resources Management.

If you have any questions about this evaluation form, please feel free to contact us by email at mrbi@llu.edu or phone at 909-651-4001.

Relationship to Student

Your Title

Your Email

Your Phone Number

Your confidential evaluation of this individual in regards to the items listed below is appreciated. Using the following guidelines, please rate the applicant in the following general areas by selecting the appropriate option.

Excels - Performance significantly exceeds acceptable requirements.
Good - Performance exceeds acceptable requirements.
Average - Performance meets acceptable requirements.
Fair - Performance less than acceptable requirements.
Poor - Performance significantly below acceptable requirements.
N/A - Performance not demonstrated or observed

Adaptability/Flexibility

Commitment to excellence

Commitment to service

Teamwork & cooperation

Sensitivity toward people from different backgrounds, culture, and age

Analytical thinking

Attitude toward supervisor

Professional appearance

Interpersonal communication skills

Overall rating

How would you describe the applicants strengths?

To become a respected leader, what areas would the applicant need to improve?

Additional comments

Has applicant expressed interest in a health care career?

Has applicant expressed interest in denominational employment?

May we contact you if we have additional questions about the applicant?

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