CAMC Employment Services
Attention: April Yoak
Post Office Box 1547
Charleston, WV  25326

RN Candidate / Nurse Extern


Reference Request
We would appreciate it if you would furnish us with as much of the information requested as possible.  The information given to us will be held strictly confidential.  If there are any other comments that you do not wish to put into writing, please contact Employment Services at (304) 388-3478 (collect).  We would appreciate your prompt attention to this matter.
Name:   Date of Graduation:  
Signature of applicant      
Degree Pursuing: ADN  BSN  Diploma  

Please rate the applicant on the following:
Characteristics Outstanding Above Average Average Below Average No Opportunity To Observe
Dependability          
Problem Solving Ability          
Ability to Work in a Team          
Ability to Work Independently with Minimal Direction          
Cooperativeness          
Initiative          
 
In what capacity do/did you know applicant?  
Additional Comments:  
   
   

Signature of person providing reference:

   Date:  
Title:   Phone:  
Institution:  
Address: