Phs 1813 Form PDF Details

The PHS 1813 form, utilized by the U.S. Department of Health and Human Services, serves as a pivotal tool in the assessment procedures for applicants to the Commissioned Corps of the United States Public Health Service. Crafted to gather comprehensive feedback on an applicant's professional demeanor, abilities, and overall suitability for a role within the service, this form bridges the gap between an applicant's record and the nuanced, real-world competencies required for the position. By soliciting detailed evaluations from a range of professional contacts such as former supervisors, employers, and academicians, the form aims to paint an accurate portrait of an applicant's ability to solve problems, communicate effectively, and integrate into teams—among other criteria. In essence, it not only probes the applicant's past performance across various dimensions, including productivity, flexibility, and initiative, but it also inquires into their potential fit for specific specializations within the Public Health Service. Furthermore, the form emphasizes the importance of integrity and reliability, asking referees to report on any potential limitations that might affect the candidate's performance. With slots for detailed comments and the option for references to disclose their willingness to re-employ the applicant, the PHS 1813 form encapsulates the thorough and nuanced approach of the Public Health Services' evaluation process.

QuestionAnswer
Form NamePhs 1813 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesWootton, Exp, OMB, phs 1813

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PHS-1813

Rev. 8/10

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Commissioned Corps of the United States Public Health Service

FORM APPROVED:

OMB No. 0937-0025

Exp. Date: 08/31/2013

Office of Commissioned Corps Operations

Division of Commissioned Corps Assignments

1101 Wootton Parkway, Suite 100

Rockville, MD 20852

REFERENCE REQUEST FOR APPLICANTS TO THE

COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE

To be completed by the applicant:

Applicant’s Name (Last, First, Middle Initial)

If the reference knows you -- the Commissiond Corps of the U.S. Public Health Service applicant -- by any other name, e.g., maiden name, please indicate that name here:

Only other names the applicant has used.

Your name has been given as a reference by the individual identified above who has applied for appointment to the Commissioned Corps of the United States Public Health Service.

We would appreciate your frank and objective consideration of the requested information. To help us determine whether this person is loyal, trustworthy, and of good character, we ask that you answer all questions on the front and back of this form as fully and specifically as you can. The information you provide will be disclosed to the person identified above if he or she should so request.

The promptness of your reply will aid us greatly in our evaluation of this applicant. The information furnished by former supervisors, employers, or college deans with the same or related background provides valuable information for use in evaluating applicants.

Office of Commissioned Corps Operations

1. PERIOD OF ASSOCIATION

2. PROFESSIONAL RELATIONSHIP TO APPLICANT (CHECK APPROPRIATE BOXES.)

 

 

 

 

 

 

From

To

EMPLOYER

TEACHER

FACULTY ADVISOR

 

 

 

 

 

 

 

 

(MM/YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISOR

DEAN

OTHER (SPECIFY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.EVALUATION OF APPLICANT (PROVIDE ANY DETAILS IN SECTION 7.)

ELEMENTS

OUTSTANDING

THANBETTER AVERAGE

AVERAGE

AVERAGEBELOW

FORBASISNO JUDGMENT

ELEMENTS

PRODUCTIVITY

 

 

 

 

 

ABILITY TO WORK WITH AND FOR OTHERS

ABILITY TO WORK INDEPENDENTLY

 

 

 

 

 

FLEXIBILITY -- ADAPTABILITY

INITIATIVE

 

 

 

 

 

ABILITY TO SOLVE PROBLEMS --

 

 

 

 

 

 

APPLICATION OF SKILLS AND KNOWLEDGE

 

 

 

 

 

RESOURCEFULNESS

 

 

 

 

 

 

CAPACITY FOR DEVELOPMENT

 

 

 

 

 

ORIGINALITY

ATTENDANCE

 

 

 

 

 

JUDGMENT

DEPENDABILITY IN CARRYING OUT

 

 

 

 

 

ABILITY TO COMMUNICATE (ORAL/WRITTEN)

 

 

 

 

 

 

ASSIGNMENTS

 

 

 

 

 

SUPERVISORY ABILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

OUTSTANDING

BETTER THAN AVERAGE

AVERAGE

BELOW AVERAGE

NO BASIS FOR JUDGMENT

4.APPLICANT IS BEST SUITED FOR WHAT SPECIALIZATION, FIELD, OR POSITION

5.DO YOU KNOW OF ANY LIMITATIONS OR OTHER INFORMATION WHICH MIGHT IMPACT ON THE EFFECTIVENESS OR STABILITY OF THIS PERSON? (Training, Personality, Emotional, Ethical)

NO

YES (Give Details in this Space)

(Continue on reverse side)

PSC Graphics (301) 443-1090 EF

6.WOULD YOU BE WILLING TO EMPLOY OR RE-EMPLOY THIS PERSON IF YOU HAD AN OPENING REQUIRING THE GENERAL PROFESSIONAL LEVEL AND PROFESSION OF THIS INDIVIDUAL?

YES (IN WHAT CAPACITY?)

NO (GIVE REASONS)

7. COMMENTS (Please use this space to supply any further information, comments from section 3 and/or evaluation.)

8.SIGNATURE

9.NAME (Type or Print)

12.INSTITUTION OR FIRM ADDRESS (Include ZIP Code) (Do not attach business cards)

10. TITLE OR POSITION

11. DATE

Telephone No. (

)

Ext.

PHS-1813 (BACK) Rev.8/10

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Step # 1 in completing phs 1813

2. Once your current task is complete, take the next step – fill out all of these fields - PERIOD OF ASSOCIATION, PROFESSIONAL RELATIONSHIP TO, From, MMYYYY, EMPLOYER, TEACHER, FACULTY ADVISOR, SUPERVISOR, DEAN, OTHER SPECIFY, EVALUATION OF APPLICANT PROVIDE, G N D N A T S T U O, N A H T R E T T E B, E G A R E V A, and E G A R E V A with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Completing part 2 in phs 1813

3. This third step should also be quite straightforward, PROFESSION OF THIS INDIVIDUAL, YES IN WHAT CAPACITY, NO GIVE REASONS, and COMMENTS Please use this space to - all these fields must be filled out here.

Simple tips to fill out phs 1813 stage 3

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phs 1813 completion process clarified (portion 4)

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