Complete this form on each applicant interviewed. Demonstrate adherence to Equal Employment Opportunity guidelines by documenting the reasons that decisions were made to employ or reject a candidate. The criteria can be tailored to the position, but each candidate must be evaluated on the same criteria. All statements must list specific job qualities and/or characteristics, which determined the applicant’s selection or rejection. Only one form needs to be submitted per panel with the panel’s combined summary documented. Once completed, attach all review selection documentation, questions, responses, signed original applications, reference checks and a completed Form 8.42 Recommendation for Hire and send to Human Resources.
SECTION 1 – Candidate Information
Candidate Name:
Position Interviewed For:	Date of Interview:
SECTION 2 – Evaluation
Technical Qualifications/Experience: (overall understanding and practical application)
Strengths:
Concerns:
Communications Skills/Interpersonal Skills/Collaboration: (clarity of ideas, direct answers, personal presentation, working with others – peers, management, team)
Strengths:
Concerns:
Leadership: (teambuilding, volunteer, supervisory, organizational, management)
Strengths:
Concerns:
Fit with VDOF: (interest in VDOF, motivation to work here, ability to work with the team)
Strengths:
Concerns:
SECTION 3 – Recommendation
Decline for Hire (complete Section 4)	Recommend Second Phase	Recommend for Hire (complete Section 4 and Form 8.41 Recommendation for Hire)
SECTION 4 – Disposition
Directly-related reason this candidate was NOT selected. Insert appropriate number from the list below:
The following reasons for rejecting candidates are acceptable as long as the same statement cannot be applied to the person selected. Does not meet minimum job specifications. Meets minimum specifications, but not best qualified. No prior related experience. Less prior related experience than person selected. Cannot meet physical standards for the position. Lower level of required skills than person selected. Less directly related training than candidate chosen. Cannot work the schedule or hours required. Applicant withdrew from consideration. Other (job-related reason)
Job-related reason the candidate selected was the best qualified:
SECTION 5 – Panel Member Agreement
All panel members must indicate their agreement/disagreement of the summaries and recommendation within this evaluation:
Agree	Disagree
Comments:
Panel Member Name (Print)	Panel Member Signature	Date
Agree	Disagree
Comments:
Panel Member Name (Print)	Panel Member Signature	Date
Agree	Disagree
Comments:
Panel Member Name (Print)	Panel Member Signature	Date
Agree	Disagree
Comments:
Panel Member Name (Print)	Panel Member Signature	Date