PARKLAND REGIONAL HEALTH AUTHORITY
REFERENCE CHECK
APPLICANT:
THOMAS B. KARIKOTTU
DATE: 11/Mar/2014 COMP :$ Par! !i%e TELEPHONE: 204$'4($0)1*
POSITION APPLIED FOR: Regi !ere" N#r e REFEREE&S NAME: Mary grace barrio TITLE : C+arge N#r e NAME OF COMPANY: Da#,+i- Regi.-a/ Hea/!+ REFERENCE COMPLETED 0Y: DATE EMPLOYED FROM:
TO:
SELECTION CRITERIA
10a e" O- Ma2.r Re ,.- i3i/i!ie Li !e" I- P. i!i.- De 4ri,!i.-5
66
COMMENTS
Communication skills with coworkers & clients Client interactions? (Empathetic, understanding) Maintains confidentiality of information & records? A ility to effecti!ely inter!ene in emergency situations Assessment & planning & documentation skills Ad!anced skills? Moti!ated? "eam #layer? $ork independently? Adherence to policy & procedure? A le to effecti!ely priori%e workload & &o demands?
66 1 7 Nee" I%,r.8e%e-!9 2 7 Pr.:i4ie-!9 * 7 Hig+/; Pr.:i4ie-!9 4 7 U-!e !e" .r U-<-.=-
P/ea e "e 4ri3e +.= ;.# ra!e !+e :.//.=i-g 3; i-"i4a!i-g: P 7 P..r9 F 7 Fair9 A 7 A8erage9 .r G 7 >er; G.." 1 5 ATTENDANCE 1 5 RELIA0ILITY 1 5 GENERAL ?ORK HA0ITS 1 5 TEAM PLAYER 1 5 INITIATI>E 1 5 INTERPERSONAL SKILLS/CO$?ORKERS @ SUPER>ISORS
I !+ere a-;!+i-g e/ e ;.# =.#/" /i<e !. a""A B
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?.#/" ;.# re$+ire !+i ,er .-A 1 5 YES
1 5 NO
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Sig-a!#re
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