Temporary Evaluation Form

Name:

Position Title:

Assignment Start Date(s):

Dependability:

Attitude:

Knowledge of Skills Requested:

Quality of Work Peformed:

Communication Skills:

Patient Interaction:

Initiative and Motivation:

Overall Rating:

Arrives on time and ready to work:

Additional Comments:

Would you request employee again?

Evaluator Name:

Evaluator Title:

Dentist/Practice Name:

Phone:

Email: