ABMLI Reference Form - Colleague Form

To be completed by a colleague who has definite knowledge of applicant’s training and experience in medical microbiology.

No letter of recommendation is required.

I. APPLICANT DATA:
First Name:
Last Name:

II. REFERENCE DATA:
First Name:
Last Name:
Position Title:
Employer:
City:
State:
Country:
Phone Number:
Business Email:
 
 

III. APPLICANT'S POSTDOCTORAL EXPERIENCE IN THE LABORATORY:
Please complete with the applicant’s information based on the work with which you are familiar.
Position 1
Applicant's Title
Employer
City
State
Country
   
Position 2
Applicant's Title
Employer
City
State
Country
   
Position 3
Applicant's Title
Employer
City
State
Country
How long have you known the applicant? years   months
 
Below, please describe the applicant’s duties, giving percentages of time devoted to each of the following areas:
The percentages entered below must add up to 100%.
%
Administrative
Description:
   
% Diagnostic and Clinical
Description:
   
% Research
Description:
   
% Teaching
Description:
% TOTAL
   
Additional Comments: If you would like to provide any additional information, please do so in the space below. 

IV. VERIFICATION
By checking this box, I verify that I am qualified to provide a reference for this applicant and that all the information on this page is accurate to the best of my knowledge.