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Employer Reference

By completing this Reference Form you acknowledge and understand that: Reference checks are conducted with the understanding that the information gathered remains confidential, in so far as the law allows. The information collected during a reference check belongs to the individual being considered for a position into the program. It shall only be released to them by a written request through FOIPOP. 

 
This form must be completed by the applicant’s manager. The assessment constitutes one part of the registration process. 

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First Name of Referent:

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Last Name of Referent:

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Job Title:

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Work Mailing Address:

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Email:

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Contact Phone #:

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First Name of Applicant:

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Last Name of Applicant:

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Name of Program:

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Study Option:

Accelerated Part Time Full Time Regular Part Time

Please comment on the applicant’s ability in the following areas:


Communication:


Collaboration:


Clinical decision making;
competence in practice: 


Professional Behavior:


Leadership Skills:


General Comments:

For a printed version of this form, please contact us at 902-473-6660 or rnpdc@nshealth.ca