EXHIBIT
SUPPORT STAFF HIRING
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