Reference Questionnaire for Staff Applicant Reference for: Your Name * First Name Last Name Email * Phone * (###) ### #### Please rate the applicant on the following attributes: Achievement (ability to formulate, execute, and carry plans to conclusion) * Unknown Poor Below Average Average Above Average Excellent Teachability (willingness to accept instruction) * Unknown Poor Below Average Average Above Average Excellent Self discipline * Unknown Poor Below Average Average Above Average Excellent Well-rounded interests * Unknown Poor Below Average Average Above Average Excellent Perseverance and Adaptability * Unknown Poor Below Average Average Above Average Excellent Dependability * Unknown Poor Below Average Average Above Average Excellent Punctuality * Unknown Poor Below Average Average Above Average Excellent Common sense and Judgment * Unknown Poor Below Average Average Above Average Excellent Trustworthiness * Unknown Poor Below Average Average Above Average Excellent Friendliness * Unknown Poor Below Average Average Above Average Excellent Outgoing personality * Unknown Poor Below Average Average Above Average Excellent Ability to communicate * Unknown Poor Below Average Average Above Average Excellent Mental alertness * Unknown Poor Below Average Average Above Average Excellent Initiative * Unknown Poor Below Average Average Above Average Excellent Does the application exhibit any of the following behaviors? Please check all that apply. Laziness Procrastination Irritability Anxiety/Worry Moodiness Argumentativeness Domineering Manner Rebellioiusness Please explain any of the above selections How long have you known the applicant? * In what capacity do you know the applicant? * To your knowledge, how does this person respond under difficult circumstances? * To your knowledge, does this person ever use alcohol, narcotics, or drugs not prescribed by a physician? If so, please explain. * Can the applicant take responsibility? Please give examples. * Would you entrust the care of your child/children to this person? If no, please explain. * Describe the applicant's sensitivity to the needs, feelings, and attitudes of others. * Additional comments By checking this box, you confirm that all information provided in this form is true and accurate and agree to use it as your digital signature. * I agree Thank you!
