Oncology Nursing Society (Ons)

ONCOLOGY NURSING SOCIETY (ONS)

2016 CANDIDATE

REFERENCE FORM

Candidate’s name:

Position that candidate is being considered for:

Reference’s name:

Please check one of the following:

Reference must be from a national organization/association leader, such as members ofaboard, committee,task force, advisory board,project team, and/or special interest group, who can speak to candidate’s performance. Examples of national organizations/associations might include ONS, ONCC, ONS Foundation, ONS:Edge, Inc, ASCO, ISNCC, ACS, ANA, etc.*

Position(s) held:

Other professional colleague.*

* Please note that staff of ONS and ONS affiliates may not provide references. Additionally, current Nominating Committee members and current ONS Board members may not provide references (ONS Nominating Committee Policy, V. Recruitment and Slating of Qualified Leaders, F.)

The Nominating Committee carefully reviews reference materials in determining a candidate’s leadership qualities and abilities related to the position. The candidate has provided you the position description, qualifications, and responsibilities of the position being sought. Your input is essential in assisting us to determine the candidate’s ability to fulfill an ONS leadership position.

Only the members of the Nominating Committee of the Oncology Nursing Society will review this Reference Form. Confidentiality will be maintained. This document will be destroyed immediately at the conclusion of the slating process and at no time will it be shared with the candidate.

The Nominating Committee may contact you during the slating process (September 18, 2015) to validate the candidate’s professional qualifications and for clarification of this reference. All information provided to the Oncology Nursing Society will be kept strictly confidential and will not be disclosed to the candidate or anyone other than the members of the Nominating Committee. The candidate has signed a Consent Form releasing the Oncology Nursing Society and those providing references from any liability.

Upon completion, please email the Reference Form no later thanMonday, August 17, 2015, 12:00pmETto the Nominating Committee Chair, .

1.In what capacity and for what length of time have you known the candidate?

1. How does the candidate exhibit the following leadership qualities? Please provide specific examples where applicable.

1. Communication/Networking Skills
2. Diplomatic Interaction Skills
3. Committee/Organizational Expertise
4. Leadership Skills/Qualities
5. Commitment to ONS and Cancer Care

3.How is the candidate uniquely qualified for this position? (Please refer to Position Description/ Qualifications/Responsibilities)

4.Those elected to a national office represent ONS at a variety of professional, political and social functions. Do you have any reservations about the ability of the applicant to do so?

No Yes, if so please elaborate:

5.Is there any additional information you believe the Nominating Committee should have to assist them in their decision-making?

No Yes If yes, please explain:

I promise, to the best of my ability, to be as fair, complete, and accurate as possible in the reference I have provided for the above candidate. I realize that my reference affects not only the individual candidate but also the Oncology Nursing Society as a whole.

DateFull Name

I agree that the information above is accurate and complete

IMPORTANT! Phone number where I can be reached September 18, 2015:

Thank you for your thoughtful evaluation. If you have any questions or need assistance regarding the candidate reference form submission process please contact ONS 412-859-6256.

Members of the Oncology Nursing Society - Nominating Committee

Rev: 06/2010; 6/2011; 1/2014

Integrity, Innovation, Stewardship, Advocacy, Excellence, Inclusiveness