Reference Form

 

Name of Reference                                                                                                                         

How long have you known the applicant?  _____In what capacity?                                                

Company (If Applicable)                                                                                                                         

Dates of Employment:  From            /          To          /         Position                                           

Current Employee?  Yes  No   If no, is he/she eligible for rehire?  Yes No

Do you find this individual to:

1. Be reliable?                                                    Yes No
2. Work well with children?                                Yes No
3. Communicate well with others?                    Yes No
4. Be a self-starter?                                           Yes No
5. Be responsible?                                             Yes No
6. Be a team player?                                         Yes No
7. Work well with diversity?                               Yes No 
8. Work well under stress?                                Yes No
9. Have an overall positive attitude?                Yes No 

Please explain any “No’s” from above                                                                                                                                                                                                                                                                                                                                                                                                                       

Any other information you would like to share regarding the applicant:                                                                                                                                                                                                                                                                                                                                                                    

                                                                                                                                                           

Signature of person filling out reference                                                                                Signature of staff person (if done by phone)