HTML Preview Nursing Job Reference Letter page number 1.
1615 South Federal Highway Suite 300 Boca Raton, FL 33432
Toll Free Tel: 800.884.8788 Toll Free Fax: 888.884.6510
www.americantraveler.com www.50statesstaffing.com www.travelforce.com
Revised: 04/2009
Reference
Letter
Verification of Employment
Applicant’s Name_________________________________________SSN___________________Employment Dates ___________to___________
Name used at time of employment______________________________________________________ Travel Per Diem Core Staff
Role: RN LPN ORT ALLIED Please Indicate:_____________________ OTHER Please indicate:______________
Unit or Area worked________________________________ Reason for Leaving: Resignation Termination Temporary Employee
Eligible for Rehire? Yes No If no, please explain______________________________________________________________
Please print clearly in black ink
Reference Given by: Title
Facility Unit/Area
Address
City State Zip
Phone Fax
Signature Title Date
Verified Employment Dates Only
Evaluation: Please check the appropriate boxes below to best describe the applicant’s performance.
Performance Evaluation
Excellent
Very
Good
Satisfactory
Needs
Improvement
Poor
N/A
Clinical Competence
Willingness to Float
Accurately Documents
Follows Patient Care Plan
Follows Safety / Emergency Procedures
Patient / Family Communication Skills
Professional Attributes
Adaptability / Dependability
Attitude
Attendance
Cooperation / Teamwork
Interpersonal Skills
Leadership Ability
Comments: _________________________________________________________________________________________________
_________________________________________________________________________________________
For Corporate Use Only
Date/Time ___________________ Verified by ____________________ Signature _________________________________
Notice to Employer
The applicant has applied to American Traveler and affiliates for employment
and has submitted your name as a former employer for reference purposes. Our
responsibility and commitment to our client hospitals is such that any
consideration of the individual is dependent upon receipt of satisfactory
references. Therefore we would appreciate you cooperation in answering the
questions below. Your responses will be kept in the strictest of confidence.
Thank you.
I hereby authorize the employer to furnish the requested information
to American Traveler Staffing Professionals and affiliates.
Applicant’s Signature________________________________________
Date_______________________________________________________