ODE Counselor Reference Form

Reference Form For:

How long and in what capacity have you known the applicant?

If you employed the applicant, would you rehire?

Would you leave your child (or a child in your like) under the influence of this applicant for an extended period of time?

Do you have any reason to believe the applicant has been or is a user of illegal drugs?

Do you have any reason to believe the applicant is an excessive or irresponsible user of alcohol?

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.

Your Name:

Position:

Company:

Relationship to Applicant: