Personal Reference

This Personal Reference online form is intended to be utilized only by authorized parties. If you did not receive an invite or do not have explicit consent from the Applicant, please refrain from using this form and contact us immediately.

Applicant Name*
First Last
Reference Name*
First Last
Reference Email*
Reference Phone*
Applicant’s Employment Dates
Applicant’s Position Held
How long have you known the applicant?*
What are the applicant’s strengths and weaknesses?*
Work Performance*
- very good
- good
- average
- fair
- poor
Dependability*
- very good
- good
- average
- fair
- poor
Attendance*
- very good
- good
- average
- fair
- poor
Honesty*
- very good
- good
- average
- fair
- poor
Follows Instructions*
- very good
- good
- average
- fair
- poor
Is the applicant eligible for re-employment?
- yes
- no
Additional Comments
Name
This field is for validation purposes and should be left unchanged.

Marquette County Medical Care Facility

200 Saginaw Street ~ Ishpeming, Michigan
Phone: (906) 485-1061 ~ Fax: (906) 485-4080

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