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DATES & RATES
Reference Form
First Name of Applicant
*
Last Name of Applicant
*
Attendance/Punctuality
*
Excellent
Good
Fair
Not Applicable
Honesty/Dependability
*
Excellent
Good
Fair
Not Applicable
Work Habits/Organization
*
Excellent
Good
Fair
Not Applicable
Adaptability/Flexibility
*
Excellent
Good
Fair
Not Applicable
Attitude
*
Excellent
Good
Fair
Not Applicable
Relationship With Co-Workers
*
Excellent
Good
Fair
Not Applicable
Leadership Abilities
*
Excellent
Good
Fair
Not Applicable
Ability To Work In Groups
*
Excellent
Good
Fair
Not Applicable
Responsibility
*
Excellent
Good
Fair
Not Applicable
Personal Appearance
*
Excellent
Good
Fair
Not Applicable
Ability To Relate To Children
*
Excellent
Good
Fair
Not Applicable
Childrens' Response To Applicant
*
Excellent
Good
Fair
Not Applicable
Ability To Control Emotions
*
Excellent
Good
Fair
Not Applicable
Sense Of Humor
*
Excellent
Good
Fair
Not Applicable
Would you be willing to leave your children under the applicant's supervision for a period of up to eight weeks? Please explain.
*
Does the applicant show signs of any behavior which would cause concern when working directly with children?
*
How long have you known the applicant?
*
What is your relationship to the applicant?
*
Any general recommendations or comments?
*
Your Name
*
Your Email
*
Your Position
*
Your Company
*
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