53.

Employee Referral
Date ________________________
Name of Candidate Referred _____________________________________________________
For the Position of _____________________________________________________________
Department ___________________________________________________________________
My relationship and knowledge of this candidate is:
 Former Work Peer
 Former Supervisor
 Former Subordinate
 Friend
 Other
____________________________________________________________________________
My evaluation of this candidate is: (5 equals highest)
Experience 1 2 3 4 5
Job-Related Skills 1 2 3 4 5
Initiative 1 2 3 4 5
Responsibility 1 2 3 4 5
Related Education 1 2 3 4 5
Interpersonal Skills 1 2 3 4 5
Comments and Other Information:
_____________________________________________________________________________
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_____________________________________________________________________________
_
_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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Submitted by _________________________________________ Date ____________________

Please attach résumé.