8/17/2019 Competency Rating Template

1/3

KP IT TALENT ACQUISITION

CANDIDATE INTERVIEW EVALUATION FORM

Position Title: Interviewer’s Name: 

Candidate’s Name:  Interview Date: XX/XX/2010

PLEASE COMPLETEBOTH PAGES OF THIS FORM IMMEDIATELY AFTER YOUR

INTERVIEW AND FORWARD TO DICK FEARN VIA EMAIL (PREFERRED) OR FAX TO

626-564-3051. THANK YOU FOR YOUR PARTICIPATION.

Technical/Job Skills Rating*

Job Requirements 5 4 3 2 1

Technical Competence 5 4 3 2 1

Relevant Skills 5 4 3 2 1

Relevant Prior Work Experience 5 4 3 2 1

Relevant Scope/Scale Experience 5 4 3 2 1

* 5 – Excellent, 4 – Above Average, 3 – Average, 2 – Below Average, 1 – Did not demonstrate

N/A – Did not evalate !leave blan"#

Core Behaviors Rating*

Focus On The Customer 5 4 3 2 1

Collaborates 5 4 3 2 1

Takes Accountability 5 4 3 2 1

Drives For Results 5 4 3 2 1

Communicates Effectively 5 4 3 2 1

Champions Innovation & Change 5 4 3 2 1

Develops Self & Others 5 4 3 2 1

* 5 – Excellent, 4 – Above Average, 3 – Average, 2 – Below Average, 1 – Did not demonstrate

N/A – Did not evalate !leave blan"#

Menu Behaviors Rating*

Thinks & Acts Strategically 5 4 3 2 1

Exerts Influence 5 4 3 2 1

Business Acumen 5 4 3 2 1

Makes Effective Decisions 5 4 3 2 1

Solves Problems Through Planning & Analysis 5 4 3 2 1

Leverages Technology 5 4 3 2 1

Demonstrates Resource Stewardship 5 4 3 2 1

8/17/2019 Competency Rating Template

2/3

Demonstrates Creativity 5 4 3 2 1

Pays Attention To Detail 5 4 3 2 1

Deals With Ambiguity 5 4 3 2 1

* 5 – Excellent, 4 – Above Average, 3 – Average, 2 – Below Average, 1 – Did not demonstrate

N/A – Did not evalate !leave blan"#

KP IT TALENT ACQUISITION

CANDIDATE INTERVIEW RATING FORM

Page 2

Additional Observations/Comments/Notes:

Summary Recommendation:

Would you recommend the hiring of this candidate forthis position?

Strong Candidate

+++

Good Candidate

++

Borderline Candidate

+/-

Would Not Recommend

--

 

(Please check one block)

8/17/2019 Competency Rating Template

3/3

Would you recommend the hiring of this candidate forother positions within KP IT?

Strong Candidate

+++

Good Candidate

++

Borderline Candidate

+/-

Would Not Recommend

--

 

(Please check one block)

CONFIDENTIAL

This Candidate Interview Rating Form was prepared by KPIT Ta!ent A"#$isition and on"e% "omp!eted by theInterviewer% is "on&identia!' This in&ormation sho$!d be restri"ted on!y to those KPIT emp!oyees designated asparti"ipants &or this parti"$!ar sear"h and is intended &or interna! $se on!y' Kaiser Permanente is pro$d to be anEOE(AA emp!oyer'