Name of Applicant
*
First Name
Last Name
Reference Name
*
First Name
Last Name
Relationship to Applicant
*
Reference Phone Number
*
-
Area Code
Phone Number
Reference email
How long have you known the applicant and in what capacity?
How well does this applicant collaborate with their peers and supervisor(s)?
In what areas do you think the applicant would excel in this position? Where do you think they would need the most support?
In what areas do you think the applicant would need the most support in this position?
Would the applicant live well in a dormitory setting?
Have you ever witnessed any inappropriate or illegal behavior on the part of the applicant?
What age group do you think would be the best fit for the applicant?
Please Select
3-6
7-9
10-13
Please select a word or phrase to describe the applicant in the following categories:
Work Habits
Please Select
Resents Suggestions
Meets Expectations
Very Teachable
Self-Starter
Unusual Perseverance
Work-A-Holic
Personality
Please Select
Cold
Shy
Quiet
Reserved
Friendly
Warm
Outgoing
Overbearing
Interaction with Peers
Please Select
Avoided
Tolerated
Liked
Well-Liked
Respected and Sought-out
Leadership Ability
Please Select
Hates being responsible
Reluctant
Leads when needed
Takes command
Grabs Control Regardless
Temperament
Please Select
Adaptive
Innovative
Timid
Easily Overwhelmed
Aggressive
Please use the scale below to rate the applicant in the following areas:
Poor
OK
Average
Exceptional
Never Seen Better
Flexibility (Adjusting to new conditions or duties)
Personal Integrity (Honesty and good decision making)
Quality of work (Accuracy/Thoroughness)
Attitude (Disposition toward hard work and authority)
Dependability (Reliability and task completion)
Creativity (Ability to problem solve or innovate new ideas)
Please choose one of the following regarding the applicant for this job:
Strongly Recommend
Recommend
Recommend with hesitation
Do not recommend this applicant for this job
Is there any information that would be best communicated over the phone?
Yes
No
Additional Comments:
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