Usarec Form 195 PDF Details

Exploring the key components of the USAREC Form 195 unveils its critical role in assessing the suitability of individuals applying for positions within the Army Medical Department. This Applicant Evaluation Worksheet serves as a comprehensive tool, gathering insights from references provided by the applicant. Designed to capture a broad spectrum of evaluations, it seeks information on the applicant's current specialty, the nature of their employment, and the work environment they thrive in, whether in clinical settings, as a student, or in private practice. It extends its inquiry to the professional qualities of the applicant, asking referees to rate attributes essential for an Army Officer—ranging from adaptability to leadership potential and professional demeanor. The form offers a structured avenue for referees to convey their overall impression and willingness to work with the applicant again, thereby providing a rounded view of the candidate's capabilities and character. Furthermore, it accommodates specific provisions for dietetic internship students, showing its adaptability to varied applicant backgrounds. By submitting detailed feedback, referees contribute significantly to a meticulous selection process, underlining the USAREC Form 195's importance in ensuring that the Army Medical Department is staffed with individuals of the highest calibre.

QuestionAnswer
Form NameUsarec Form 195
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names195 worksheet, usarec form 195, 195 a form, new york state 195 form fillable

Form Preview Example

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

 

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

part-time or

b. Describe the applicant's current work environment. If a student/resident describe course and/or clinical setting/environment:

5. Select only one:

 

(mmyy)

 

(mmyy)

 

 

 

I evaluate/have evaluated this applicant.

From

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am/have been a peer/coworker of this applicant.

From

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am/have been an instructor/preceptor for this applicant.

From

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I know/have known this applicant. Specify in what capacity you have known

From

 

To:

 

 

 

 

 

 

 

this applicant:

 

 

 

 

 

 

 

 

 

 

 

6. Would the applicant make a good Army Officer? Overall impression of the applicant:

7. Would you hire/rehire/work with this applicant?

Yes

No If no, please explain:

USAREC Form 195, Rev 1 Apr 11

PREVIOUS EDITIONS ARE OBSOLETE

V2.10

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

2

3

4

5

6

7

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.

USAREC FORM 195, REV 1 APR 11 (REVERSE)

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Filling out part 1 in 195 form wage

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195 form wage completion process detailed (portion 2)

3. The next section is considered quite straightforward, AdaptabilityResourcefulness, Clinical Judgment, Clinical Knowledge, Clinical Skills, HonestyIntegrity, Initiative, Interaction with Coworkers, Leadership AbilityPotential, Managerial AbilityPotential, Manner in Accepting Criticism, Professional Appearance, Professional Demeanor, Reliability, Stability Under Pressure, and Stamina Mental and Physical - all these form fields must be completed here.

HonestyIntegrity, Professional Demeanor, and Clinical Skills of 195 form wage

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4. This subsection arrives with the following empty form fields to focus on: Analytical Skills, Conceptual Skills, Communication Skills, Maturity, Assumes Responsibility, Judgment, Dietetic Internship Students may, Additional CommentsRemarks, Name Print, Signature, PositionTitleSpecialty, Business Address, Telephone Number, and Date.

Filling out section 4 in 195 form wage

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The way to fill out 195 form wage portion 5

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