SAMPLE
REPORT 6
TABB INC.
HUMAN RESOURCE SERVICES
SERVICE IS OUR NUMBER ONE
PRIORITY
PO BOX 10; 555
E. Main St., Chester, NJ 07930
TELEPHONE(908)879-2323/FAX NO. 879-8675
www.tabb.net
The
information contained in this report is for the SOLE AND
CONFIDENTIAL use of the subscriber.
| Name |
Social
Security No. |
Date
Received |
|
|
|
|
|
|
| Address |
Company Name |
|
|
|
|
|
|
|
|
Request By |
|
|
|
|
|
|
|
|
DATABASE:
A database
search under the applicant's social security number show the name
...................... and the following cities and state(s):
Trenton, NJ; Philadelphia, PA and New York, NY
CRIMINAL RECORDS:
A
statewide criminal record search was conducted in New Jersey. There
is no record of a felony or misdemeanor conviction under the
applicant's name, date of birth and social security
number.
A
statewide criminal record search was conducted in New York and
there is no record of a felony or misdemeanor conviction under the
applicant's name and date of birth.
A
statewide criminal record search was conducted in Pennsylvania and
there is no record of a felony or misdemeanor conviction under the
applicant's name and date of birth.
EDUCATION:
XYZ University
Dates Given: 5/96
Dates
Confirmed:5/1/96
The Registrar confirmed
the applicant received a Bachelor of Science with a major in
Biology on 5/1/96. The applicant's GPA was 3.12.
EMPLOYMENT:
XYZ Medical Center
Dates Given: 2/02-5/05
Dates
Confirmed: 2/02-5/05
Mr......................, Human Resources Representative,
confirmed the applicant was employed as a Nuclear Medicine
Technician by the hospital from February of 2002 until resigning in
May of 2005. Mr. ....................... was informed of the Health
Care Professional Responsibility and Reporting Enhancement Act and
verified that the facility has not provided any notice to the
licensing board or to the review panel with respect to this
applicant's impairment, incompetence, professional misconduct,
involvement in adverse patient care or safety, involvement in drug
or alcohol abuse, involvement in intervention programs or any other
issue as it relates to patient care or safety. The applicant
resigned voluntarily from the position and would be eligible to
return. The applicant's supervisor, Ms. ................... , Chief
of Technology, worked with the applicant for well over three years.
The applicant started as a student at the hospital and was hired by
the hospital after the completion of the course. The applicant's
performance is described as being beyond expectations. The
applicant left the hospital due to the long commute and will be
missed by all in the department. The applicant was a senior person
in the department and the department hated to lose the applicant.
The applicant was the right hand person to Ms. .............. and
has been an asset to the department and the hospital. The applicant
is an experienced technician who has excellent technical skills and
excellent patient rapport. The applicant is highly motivated and
worked with less experienced technicians in the department to
improve their skills. In addition, the applicant is described as
being a genius with the computer, handling all computer problems
and applications without requiring assistance from the hospital's
technical staff. The supervisor has a high regard for the applicant
and highly recommends the applicant for employment at any hospital.
The supervisor stated the applicant's commute was the main factor
in the applicant leaving this hospital and seeking other
employment.
ABC
Medical Center Dates Given:1/98-1/02
Dates Confirmed:1/98-1/02
Ms.
............... , Human Resources Secretary, confirmed the
applicant was employed as a full-time Radiology Technician from
1/98 until 1/02. Ms. ................ was informed of the Health
Care Professional Responsibility and Reporting Enhancement Act and
verified that the facility has not provided any notice to the
licensing board or to the review panel with respect to this
applicant's impairment, incompetence, professional misconduct,
involvement in adverse patient care or safety, involvement in drug
or alcohol abuse, involvement in intervention programs or any other
issue as it relates to patient care or safety. The applicant
resigned voluntarily from the position and would be eligible to
return. The applicant's former supervisor, Mr.
...................... , Assistant Director, has known the
applicant for many years. The applicant started at the hospital as
an intern and after completing the internship the applicant was
hired on a full-time basis. The applicant's performance as a
Radiology Technician was described as very good. The applicant has
excellent technical skills according to Mr. ................... and
operates efficiently and professionally. The applicant understood
the balance of getting patients in and out of the department in an
efficient manner while meeting the concerns of patients and
technical requirements. The applicant is very friendly and works
well with both patients and employees. In addition, the applicant
was reliable and dependable. Mr. ............. has a high regard
for the applicant and his technical skills. The applicant left for
a new opportunity at another hospital and would be eligible to
return. Mr. …………… verified that the
facility has not provided any notice to the licensing board or to
the review panel with respect to this applicant's impairment,
incompetence, professional misconduct, involvement in adverse
patient care or safety, involvement in drug or alcohol abuse,
involvement in intervention programs or any other issue as it
relates to patient care or safety.
REPORT BY:
ZA
