Reference Form
Please fill out this form to the best of your ability.
Name of Applicant
First Name
Last Name
Today's Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Reference
First Name
Last Name
Your Phone Number
*
-
Area Code
Phone Number
Email
*
How long have you known this applicant?
*
What is your relationship to the applicant?
Co-worker
Employer
Family Member
Friend
Professional Contact
Family Friend
Mentor/Minister
Other
How would you rate the applicant’s ability to work with and relate to students?
Above Satisfactory
Satisfactory
Below Satisfactory
We are looking for someone who can stay calm and control frustration even under very frustrating conditions with children or students. How would you rate the applicant’s ability to be patient and stay calm?
Above Satisfactory
Satisfactory
Below Satisfactory
How would you rate the applicant’s ability to relate with adults?
Above Satisfactory
Satisfactory
Below Satisfactory
We need a person who can be supportive and understanding to a child or student. How would you rate the applicant’s ability to be genuinely supportive and understanding to a person in need?
Above Satisfactory
Satisfactory
Below Satisfactory
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Reference Form
This section will ask a few questions about the applicant. Please give as much detail as you can.
If your relationship to the applicant was job related, please elaborate on the applicant's roles and responsibilities.
Again, if your relationship to the applicant was job related, would you work with the applicant again?
Can you tell me about the candidate's strengths? Their weaknesses?
Have you seen the applicant working with children or students first hand? Can you give an example of how the applicant relates to children or students?
Have you ever known the applicant to use harsh or abusive discipline with a child or student? Do you know of any reason the applicant would pose a danger to any child or student?
Would you be comfortable placing one of your own children in the care of the applicant? Why or why not?
What are the applicant’s hobbies and recreational activities?
Can you give me an example of how the applicant relates with adults?
If you can think of a time when the applicant was able to show genuine concern for a person who needed comfort, please tell about that time.
Do you have any additional comments or questions?
Submit
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