Staff Reference Form

Applicant Information

Name of Applicant*

First

Last

How long have you known the applicant?

In what capacity?

Rate the applicant in the following areas

Dependability

Additional Comments

Promptness

Additional Comments

Maturity

Additional Comments

Work Ethic

Additional Comments

Cooperation

Additional Comments

Leadership

Additional Comments

Enthusiasm

Additional Comments

Responsibility

Additional Comments

Patience

Additional Comments

Flexibility

Additional Comments

Communication

Additional Comments

Loyalty

Additional Comments

Additional Questions

Would you consider the applicant a good role model for children?

Yes
No

Please explain

Is the applicant a team player and can she/he follow rules?

Yes
No

Please explain

What words or phrases immediately come to mind when describing the applicant?

What weaknesses or limitations have you observed in the applicant?

My overall recommendation*

Your Information

Name*

First

Last

Position

Email*

Phone

Date

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