Healthcare Nursing Skills Employment Evaluation Form
Comprehensive assessment of nursing candidates for employment suitability.
Candidate Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Position Applied For
*
Please Select
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Certified Nursing Assistant (CNA)
Nurse Practitioner (NP)
Other
Highest Nursing Qualification Achieved
*
Please Select
Diploma
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate (PhD, DNP)
Other
Please list current nursing certifications (e.g., BLS, ACLS, PALS)
Core Nursing Skills Assessment
*
Rows
Excellent
Good
Fair
Needs Improvement
Patient Assessment
1
2
3
4
Medication Administration
5
6
7
8
Infection Control Practices
9
10
11
12
Wound Care
13
14
15
16
Documentation & Charting
17
18
19
20
Patient Communication
21
22
23
24
Emergency Response
25
26
27
28
Scenario-Based Clinical Judgment: Please rate the candidate's ability to respond appropriately to clinical scenarios.
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Professional References (names and contact details)
Evaluator's Comments / Recommendations
Evaluator Full Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluator Signature
*
Submit Evaluation
Submit Evaluation
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