Interview Feedback Form

1. Interview Evaluation Form
Applicant’s Name Job Title of Position Applied For
Interviewer’s Name Date of Interview
Type of Applicant
External
Internal (Employee)
Level of Interview (check one)
Initial Screening
In-depth Interview
Type of Interview (check one)
Human Resource Interview
Supervisor/Manager
Interview
COMPETENCY PROFILE
COMPETENCY PROFILE
Don’t Know
(not enough
information)
RATING SCALES
Does not
Achieve
Expectations
Partially
Achieves
Expectations
Achieves
Expectations
Exceeds
Expectations
Greatly
Exceeds
Expectations
Major
Development
Need
Development
Need
Neither
Strength nor
Development
Need
Strength Major Strength
Communication and Interpersonal Skills
Oral
Communication/Listening 1 2 3 4 5
Documentation skills 1 2 3 4 5
Co-Worker
Relations/Teamwork 1 2 3 4 5
Customer Relations 1 2 3 4 5
Personal Effectiveness Skills and Traits
Problem Solving 1 2 3 4 5
Time
Management
1 2 3 4 5
Quality 1 2 3 4 5
Initiative and Perseverance 1 2 3 4 5
Personal Integrity 1 2 3 4 5
Adaptability 1 2 3 4 5
Stress Tolerance 1 2 3 4 5
Self-Development 1 2 3 4 5
Commitment 1 2 3 4 5
Job Specific Skills and Experience
Experience 1 2 3 4 5
Education / Training 1 2 3 4 5
Technical Skills - Mandatory 1 2 3 4 5
Technical Skills – optional 1 2 3 4 5
Certification 1 2 3 4 5
Interest & Knowledge of the
open positions at Envision
1 2 3 4 5
Presentation 1 2 3 4 5
Job Stability 1 2 3 4 5
Other Job-Related Criteria
(if any)
1 2 3 4 5

2. OVERALL RATING OF PROBABILITY OF SUCCESS (Circle 1 appropriate Rating as identified)
5 High
Based on the competency profile, there is a very good (80-100%) probability that this person
will be successful on the job.
4
Moderate
Based on the competency profile, there is a good (60-80%) probability that this person will be
successful on the job.
3 Based on the competency profile, there is a moderate (40-60%) probability that this
person will be successful with adequate job training and on-the-job coaching.
2 Based on the competency profile, there is a poor (20-40%) probability that this person
will be successful one the job. Training and on-the-job coaching are not likely to correct
problem areas.
1 Low Based on the competency profile, there is a very poor (0-20%) probability that this person
will be successful on the job. Training and on-the-job coaching are extremely unlikely to
correct problem areas.
Please circle your responses to the following questions:
1. The applicant has the knowledge, skills, and abilities to perform the duties of this position.
Strongly Agree Agree Disagree Could not determine
2. The applicant views this position with excitement and enthusiasm.
Strongly Agree Agree Disagree Could not determine
3. The applicant has the appropriate level of experience necessary for this position.
Strongly Agree Agree Disagree Could not determine
4. The applicant displayed the ability to participate effectively in a team environment and motivate and lead the staff (if
applicable).
Strongly Agree Agree Disagree Could not determine
5. The applicant displayed good communication and presentation skills.
Strongly Agree Agree Disagree Could not determine
6. The applicant should be included in the final list of recommended applicants.
Strongly Agree Agree Disagree Could not determine
Candidate’s Strengths: Candidates Weaknesses:
Please provide any additional comments you have about this candidate:
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3. Signature of the Interviewer