Interim Reference Check — Whitman Partners

Interim Reference Check Form

Applicant Name(Required)

Applicant First Name Applicant Last Name

Reference Name(Required)

Your First Name Your Last Name

Your Phone Number(Required)

Your Job Title (current)(Required)

Your Employer (current)(Required)

What is your relationship to the applicant?(Required)

Name the employer you were working for alongside the applicant(Required)

What is the position you held while working with the applicant?(Required)

How long did you work together?(Required)

What was the applicant's position and responsibilities while you worked together?(Required)

For the following questions, provide examples whenever possible.

1. How would you characterize the applicant's leadership style?(Required)

2. How would you characterize the applicant's communication skills?(Required)

3. Was the applicant able to motivate staff to achieve results?(Required)

4. Was the applicant an effective mentor to staff?(Required)

5. Did the applicant demonstrate expertise of industry knowledge?(Required)

6. Did the applicant demonstrate the ability to make decisions in a timely manner?(Required)

7. Did the applicant lead any projects or initiatives that resulted in increased profits or cost savings for the perioperative services and/or sterile processing department? If so, please describe.(Required)

8. What was the applicant's most significant accomplishment with your company?(Required)

9. What are the applicant's top areas that need improvement to increase professional performance?(Required)

10. What attributes make the applicant an effective interim manager/director?(Required)

11. How would you rate the applicant's performance on a 1-10 scale? Explain your answer:(Required)

12. Would you re-hire/work with the applicant again?(Required)

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