Recommendation Form: Applicant is applying for admission into the Saint Luke's Hospital School of Medical Laboratory Science (SLH MLS) to complete requirements to qualify for certification. The program goal is to select and graduate quality Medical Laboratory Scientists. Please provide an honest and accurate evaluation of the applicant's abilities, as this is an essential factor in the selection process.

Rating scale: 1=poor, 2=below average, 3=average, 4=above average, 5=excellent

Form completion will automatically send to SLH MLS.

Date

Applicant name

How long have you known applicant?

What is your relationship to applicant?

Should this recommendation remain confidential?

Yes

Reference Name

Reference Position

Reference Place of Employment and Address

Reference Email and Phone Number

Applicant Integrity:

Academic Ability:

Motivation

Quality of Work

Judgement

Initiative

Manual Dexterity

Reliability

Cooperation

Response to Constructive Criticism

Oral Communication Skills

Written Communication Skills

Ability to Follow Oral and Written Instructions

Leadership

Emotional Stability

Additional Comments

Overall Impression

Outstanding candidate, highly recommend

Above average candidate, confidently recommend

Average candidate, recommend

Below average candidate, hesitantly recommend

Do not recommend

Reference Signature - Typed name is equivalent to signature

School of Medical Laboratory Science Recommendation