Please complete this form to the best of your knowledge.  Information provided will remain confidential

Name of Applicant:  

Name of Appraiser:  

Date:  

1.     Please indicate how well and in what context you know the potential nominee.

2.     What strengths would she bring to the organization as a member of the regional
  management team?

3.     It is important that members of the regional management team possess the following
  attributes/characteristics.  Please rate the potential nominee in each area as follows :

N/A=Unknown, 1=Poor, 2=Below Average, 3=Average, 4=Above Average, 5=Good

N/A12345 Appearance
N/A12345 Attitude
N/A12345 Communication – Verbal
N/A12345 Communication – Written
N/A12345 Confidentiality  
N/A12345 Cooperation
N/A12345 Copes Under Pressure

N/A12345 Dependability
N/A12345 Flexibility
N/A12345 Integrity
N/A12345 Intelligence
N/A12345 Leadership
N/A12345 Objectivity
N/A12345 Patience

N/A12345 Self-confidence
N/A12345 Self-motivation
N/A12345 Sense of Humor
N/A12345 Social Skills
N/A12345 Timeliness
N/A12345 Vision
N/A12345 Vitality

4.     What is the most important thing that you would like known about this potential
        member of the regional management team?

5.     What is the one concern you have about this potential member of the regional
        management team?