Reference Form

Name of Reference*

Name of Reference

First Last

Name of Potential Employee*

Name of Potential Employee

First Last

Title of Reference*

Title of Reference

Address of Reference

Street Address Address Line 2 City State ZIP Code

Phone Number of Reference

Email Address of Reference

In what capacity have you known the applicant?*

In what capacity have you known the applicant?

How many years have you known the applicant?*

How many years have you known the applicant?

Please enter a number from 1 to 100.

Rate the applicants understanding of child development*

Rate the applicants understanding of child development

Rate the applicants age appropriate activities/practice*

Rate the applicants age appropriate activities/practice

Rate the applicants communication with children*

Rate the applicants communication with children

Rate the applicants communication with adults (oral & written)*

Rate the applicants communication with adults (oral & written)

Rate the applicants ability to set limits and use positive discipline*

Rate the applicants ability to set limits and use positive discipline

Rate the applicants emphasis on health and safety*

Rate the applicants emphasis on health and safety

Rate the applicants ability to handle small and large groups*

Rate the applicants ability to handle small and large groups

Rate the applicants decision-making/judgement skills*

Rate the applicants decision-making/judgement skills

Rate the applicants ability to be sensitive and warm*

Rate the applicants ability to be sensitive and warm

Rate the applicants ability to be flexible*

Rate the applicants ability to be flexible

Rate the applicants reliability/punctuality*

Rate the applicants reliability/punctuality

Rate the applicants professional development/demeanor*

Rate the applicants professional development/demeanor

Rate the applicants problem-solving skills*

Rate the applicants problem-solving skills

Additional comments?

Name

This field is for validation purposes and should be left unchanged.

Ithaca Community Childcare Center IC3 – Where Your Child is the Center