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EXHIBIT

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APPLICANT REFERENCE CHECK

Applicant

Applicant Name:     ______________________________________   PID: ___________

Position Desired: ________________________________________________________

Reference Contact

Contact Name: _______________________________   Position: __________________

Home Phone: _______________________    Work Phone: _______________________

E-mail Address: _________________________________________________________

School/University/Company: _______________________________________________

Alternate Contact: _______________________________________________________

Evaluation

How long have you know this applicant? ______________________________________

In what capacity do you know this person? ____________________________________

On a scale of 0-4 (0 being Not Observed, 1 being Does Not Meet Expectations through 4 being Exceeds Expectations) how would you rate the applicant's job performance:

Teacher Applicants              0                        1                          2                      3                        4
        
   Only                  Not Observed    Does Not Meet          Below           Fully Meets         Exceeds
                                                                 Expectations      Expectations    Expectations     Expectations

Exhibits good teaching
strategies                               
                                                                                               

Has knowledge of
subject matter                                                                                                                        

Uses effective classroom
management techniques                                                                                                       

All Applicants         

Has knowledge of
assigned tasks                                                                                                                       

Utilizes effective
communication                                                                                                                       

Uses professional
judgment                                                                                                                               

Is cooperative with co-
workers, administra-
tors, and supervisors                                                                                                             

Develops positive 
relationships with
students, co-workers,
and supervisors                                                                                                                     

Does not abuse sick
or personal leave                                                                                                                   

Demonstrates strong
organizational skills                                                                                                               

Is punctual and
dependable                                                                                                                            

Exhibits creativity and
resourcefulness                                                                                                                     

Maintains a flexible
and positive attitude                                                                                                               

Manages work assign-
ments effectively                                                                                                                    

Accepts additional
responsibilities                                                                                                                       

Areas of strength:
 

 

Areas that need improvement:


 

Did this person ever receive a written counseling statement or 
reprimand?      Yes    No

Did the employer ever consider taking action to demote, suspend, 
non-renew, or dismiss the employee?      Yes    No

Was this person ever involved in an incident that resulted in injury 
to a student or co-worker?      Yes    No

Would you want this person supervising/working with 
your child?      Yes    No

If you had an opening in a similar position, would you employ
this person?      Yes    No

Is there any other information I have not asked about that would help us determine this person's eligibility?

 

 

__________________________________________    ________________________
Person conducting the reference check                          Date