Reference form

Applicant's Name*

First Last

Your Name*

First Last

What is your relationship to the Applicant?*

How long have your known the Applicant?*

How would you rate the applicant's ability to work with and relate to children?*

Can you give an example of how the applicant relates to children?*

We are looking for someone who can stay calm even under frustrating conditions. How would you rate the applicant's ability to be patient and calm?*

Have you known the applicant to use harsh or abusive discipline with a child? Do you know of any reason the applicant would pose a danger to any child? Are you aware of any claim of child abuse or neglect against the applicant?*

What are the applicant's hobbies and recreational activities?*

How would you rate the applicant's ability to work with and relate to adults?*

Can you give an example of how the applicant relates with adults?*

Please share any additional concerns or observations.

Would you recommend this applicant?*

Yes
No

Why did you choose No?*

Why did you choose Yes?*

Name

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