Clinical Year Student Application Reference

Wright State University Clinical Laboratory Science Program , Department of Biological Sciences

Name of applicant *

Evaluator *

Position *

Competency *

	5	4	3	2	1	NA
Technical Knowledge/Skills - Level of knowledge and/or technical skills.	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - 5	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - 4	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - 3	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - 2	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - 1	Technical Knowledge/Skills - Level of knowledge and/or technical skills. - NA
Meets required standards: i.e., accuracy, neatness and thoroughness	Meets required standards: i.e., accuracy, neatness and thoroughness - 5	Meets required standards: i.e., accuracy, neatness and thoroughness - 4	Meets required standards: i.e., accuracy, neatness and thoroughness - 3	Meets required standards: i.e., accuracy, neatness and thoroughness - 2	Meets required standards: i.e., accuracy, neatness and thoroughness - 1	Meets required standards: i.e., accuracy, neatness and thoroughness - NA
Productivity - Accomplishes the quantity of work expected of the job or assignment	Productivity - Accomplishes the quantity of work expected of the job or assignment - 5	Productivity - Accomplishes the quantity of work expected of the job or assignment - 4	Productivity - Accomplishes the quantity of work expected of the job or assignment - 3	Productivity - Accomplishes the quantity of work expected of the job or assignment - 2	Productivity - Accomplishes the quantity of work expected of the job or assignment - 1	Productivity - Accomplishes the quantity of work expected of the job or assignment - NA
Communication Skills - Ability to convey ideas both oral and written	Communication Skills - Ability to convey ideas both oral and written - 5	Communication Skills - Ability to convey ideas both oral and written - 4	Communication Skills - Ability to convey ideas both oral and written - 3	Communication Skills - Ability to convey ideas both oral and written - 2	Communication Skills - Ability to convey ideas both oral and written - 1	Communication Skills - Ability to convey ideas both oral and written - NA
Adaptability - adapts to new situations and changes in routines, workload and/or work assignments	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - 5	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - 4	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - 3	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - 2	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - 1	Adaptability - adapts to new situations and changes in routines, workload and/or work assignments - NA
Dependability - Performs work without close supervision or assistance	Dependability - Performs work without close supervision or assistance - 5	Dependability - Performs work without close supervision or assistance - 4	Dependability - Performs work without close supervision or assistance - 3	Dependability - Performs work without close supervision or assistance - 2	Dependability - Performs work without close supervision or assistance - 1	Dependability - Performs work without close supervision or assistance - NA
Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - 5	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - 4	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - 3	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - 2	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - 1	Initiative - Presents new ideas, improves procedures or otherwise demonstrates an awareness of the need for change - NA
Attendance - Maintains attendance including tardiness, leaving early and absence	Attendance - Maintains attendance including tardiness, leaving early and absence - 5	Attendance - Maintains attendance including tardiness, leaving early and absence - 4	Attendance - Maintains attendance including tardiness, leaving early and absence - 3	Attendance - Maintains attendance including tardiness, leaving early and absence - 2	Attendance - Maintains attendance including tardiness, leaving early and absence - 1	Attendance - Maintains attendance including tardiness, leaving early and absence - NA
Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - 5	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - 4	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - 3	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - 2	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - 1	Relations with Others - Establishes effective working relationships with supervisors, peers and/or the public - NA
Perseverance - Continues to progress even in negative situations	Perseverance - Continues to progress even in negative situations - 5	Perseverance - Continues to progress even in negative situations - 4	Perseverance - Continues to progress even in negative situations - 3	Perseverance - Continues to progress even in negative situations - 2	Perseverance - Continues to progress even in negative situations - 1	Perseverance - Continues to progress even in negative situations - NA
Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - 5	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - 4	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - 3	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - 2	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - 1	Self-confidence - Demonstrates assuredness in possessing the capacity to achieve goals - NA
Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - 5	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - 4	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - 3	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - 2	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - 1	Intellectual ability - Demonstrates the intellectual ability to grasp difficult concepts - NA

Please rate based on the following: 5 = excellent; 4 = above average ; 3 = average; 2 = below average; 1 = poor Please check NA if you have no basis to judge the applicant.

Attach a letter of recommendation *