Candidate Reference Check

Candidate Reference CheckJulie Smith2026-06-24T18:23:49-05:00

Candidate Reference Check

Candidate's Name*
First Last
Please rate the candidate on the following 6 questions.
1) The candidate states they handled back-office clinical responsibilities under your supervision or alongside you. How accurately does this describe their daily role?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
Optional comments on their main duties:
2) How likely is it that the candidate will consistently perform hands-on clinical tasks (e.g., injections, blood draws, vitals) with 100% accuracy and safety?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
3) How likely is the candidate to effectively calm highly anxious, fearful, or difficult patients, and clearly explain medical instructions to family members?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
4) How likely is the candidate to maintain their clinical speed, technical accuracy, and a positive attitude under high-volume, chaotic clinic stress?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
5) How likely is it that the candidate can be 100% relied upon regarding attendance, punctuality, infection control, and strict HIPAA privacy protocols?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
6) This role is for a fast-paced pediatric clinic. Based on your experience working with them, how likely are they to successfully adapt to managing young children and protective parents?*
Excellent / Highly Likely Good / Likely Fair / Neutral Poor / Unlikely Critical / Highly Unlikely
Any additional information you wish to provide:
Name*
First Last
Relationship to Candidate*
Job Title / Company
Contact Info

Candidate Reference Check

Candidate Reference Check

Please rate the candidate on the following 6 questions.