/ Department of Epidemiology, Biostatistics and Occupational Health
Département d’épidémiologie, biostatistique et santé au travail

REFEREE EVALUATION FORM AND LETTER OF RECOMMENDATION

APPLICANT
Last Name: / First Name:
REFEREE
Last Name: / First Name:
Position:
Institution: / Department:
Email: / Number of years/months that the referee has known the candidate:
Years: / Months:
Capacity in which the referee has known the candidate:
Referees who are residents of Quebec:
You should be aware that under Quebec access legislation, the candidate has the right to request access to your evaluation, whether favourable or unfavourable. The legislation also specifies that if this request is made, your name must also be made available to the candidate.
Referees who are non-residents of Quebec:
You should be aware that under Quebec access legislation, the candidate has the right of access to your evaluation, whether favourable or unfavourable. The university will not, however, disclose to the candidate your identity, or anything which might lead to the discovery of your identity.
EVALUATION FORM
1. / Please check the box which most closely represents your opinion of the applicant in comparison with individuals you have known who have had approximately the same training and experience.
Outstanding
TOP 2% / Excellent
TOP 10 % / Very Good
TOP 25% / Good
TOP 50% / Fair/Poor
Bottom 50% / Unable to Judge
Industry/perseverance
Motivation
Initiative
Maturity
Interpersonal facility with peers
Interpersonal facility with staff
Demonstrated skill at research
Judgment/critical sense
Intellectual ability
Demonstrated productivity
Potential productivity
Ability to communicate (written)
Ability to communicate (spoken)
OVERALL EVALUATION
2. / If the applicant had applied for graduate studies in your department, would you:
Accept him/her readily / Accept him/her with reservations / Not accept him/her
3. / In your opinion, would the applicant probablycomplete the graduate degree:
Without difficulty / With some difficulty / Unlikely to complete
4. / Has the applicant demonstrated originality in his/her previous work?
Yes / No / Unable to judge
If not, do you believe the applicant capable of undertaking original work:
With no difficulty / With some difficulty / With great difficulty
LETTER OF RECOMMENDATION
LETTER OF RECOMMENDATION – Continued

EBOH Referee Evaluation Form, Page 1 (10/2012)