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Get Form 195 2011-2025

Would the applicant make a good Army Officer Overall impression of the applicant 7. Would you hire/rehire/work with this applicant USAREC Form 195 Rev 1 Apr 11 Yes No If no please explain PREVIOUS EDITIONS ARE OBSOLETE V2. APPLICANT EVALUATION WORKSHEET For use of this form see USAREC Reg 601-37 NAME OF APPLICANT The above named individual is applying for a position in the Army Medical Department and has given us your name as a reference. Please complete this reference form and return in the envelope provided* 1. What is this applicant s current specialty 2. Date began employment in this specialty mmyy 3. Is this applicant check one private practice /self-employed employed full-time part-time or stipend employee If part-time or stipend please provide the average hours worked per week 4. a* If the applicant is a nurse describe the size/type of health care facility b. Describe the applicant s current work environment. If a student/resident describe course and/or clinical setting/environment 5. Select only one mmyy I evaluate/have evaluated this applicant. From To I am/have been a peer/coworker of this applicant. I know/have known this applicant. Specify in what capacity you have known this applicant 6. 10 8. The attributes listed below are important for Army Medical Department Officers. Compare this applicant with others who work in the same capacity and have the same experience level student/residents. Rate each attribute on a scale of 1 to 7 with 1 being the lowest and 7 being the highest. If the attribute cannot be evaluated or does not apply check NA. SCORE ATTRIBUTE Lowest Highest REMARKS NA Adaptability/Resourcefulness Clinical Judgment Clinical Knowledge Clinical Skills Honesty/Integrity Initiative Interaction with Coworkers Leadership Ability/Potential Managerial Ability/Potential Manner in Accepting Criticism Professional Appearance Professional Demeanor Reliability Stability Under Pressure Stamina Mental and Physical Tact Analytical Skills Conceptual Skills Communication Skills Maturity Assumes Responsibility Judgment 9. Dietetic Internship Students may use ADA American Dietetic Association Recommendation Form instead of this form* 10. Additional Comments/Remarks Name Print Telephone Number Signature Date Position/Title/Specialty Business Address E-mail Address The Army Medical Department appreciates your time and effort in providing an honest appraisal of this individual*. APPLICANT EVALUATION WORKSHEET For use of this form see USAREC Reg 601-37 NAME OF APPLICANT The above named individual is applying for a position in the Army Medical Department and has given us your name as a reference. Please complete this reference form and return in the envelope provided* 1. What is this applicant s current specialty 2. Please complete this reference form and return in the envelope provided* 1. What is this applicant s current specialty 2. Date began employment in this specialty mmyy 3. Is this applicant check one private practice /self-employed employed full-time part-time or stipend employee If part-time or stipend please provide the average hours worked per week 4. .

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