Reference Form

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Applicant's Name
How long and in what capacity have you known the applicant?
If you employed the applicant, would you rehire?		Click for YESClick For No
Would you leave your child (or a child in your like) under the influence of this applicant for an extended period of time?		Click for YESClick For No
Please explain if the answer is no.
Do you have any reason to believe the applicant has been or is a user of illegal drugs?		Click for YESClick For No
Do you have any reason to believe the applicant is excessive or irresponsible user of alcohol?		Click for YESClick For No
Responsibility
Adaptability/Flexibility
Communication Skills
Creativity
Enthusiasm/Energy
Independence
Initiative
Integrity/Honesty
Judgment/Common Sense
Leadership Skills
Maturity
Professional Appearance
Self-Confidence
Work Ethic
Please comment on any of your above responses if necessary:
Reference's Name:
Position
Company
Relationship to Applicant:
Daytime Telephone Number
Email Address

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