Perfusion Consultants / Perfusion Partners

RECOMMENDATION / EVALUATION FORM

[3] Autotrans New Hire
Responsibility
Technical Skill
Knowledge of Job Duties
Adherence to Company Rules, & Regulations
Performance of Assigned Duties
Ethics and Conduct
Emotional Stability
Cooperative Attitude Toward Others

Please complete the following evaluation based on demonstrated  job performance compared to that reasonably expected for the position that the applicant held while associated with you.  Your responses should be based on specific experience, demonstrated performance, and your direct working relationship with the applicant.

Skills
In order to comply with regulatory agency requirements to confirm identity of the applicant, a photograph of the applicant is attached. Are you able to confirm the identity of the applicant by the attached photograph?
To your knowledge has the applicant been the subject of any disciplinary actions, complaints, either related to competency or behavioral issues?
To your knowledge are there any indications of physical or mental disability or conditions, including possible dependence on drugs or alcohol, which would impair his/her professional functioning?