Page 1 of 3
EVERETT PUBLIC SCHOOLS
REFERENCE FORM FOR ADMINISTRATIVE POSITIONS
NOTE TO APPLICANT : Please complete Section 1 and then forward to your current and/or past s upervisor(s).
SECTION 1 � TO BE COMPLETED BY APPLICANT
I, __ _______________________________________, am an applicant with the Everett Pu blic Schools for an administrative position.
Please state frankly your opinion of my abilities on the form below. Thank you for your assistance.
I hereby authorize Everett Public School s to conduct reference checks to obtain information relating to my application of emplo yment
with no liab ility arising therefrom. I am advised that the reference checks may include i nformation on my character, general
reputation and personal characteristic s as they may relate to my ability to perform the job for which I am applying.
____________________________ ______________________ ___________________________________________
Signature of Applicant Social Security N umber
SECTION 2 � TO BE COMP LETED BY CURRENT AND/OR PAST SUPERVISOR
______________________________________ ______________________________ ____________________________
Print name of person completing referenc e Title Telephone Number
____ _____________________________________________________________________ _______ _____________________
Working relationship with applicant How long?
________________________________________ _________________________________ ____________________________
Signature of person completing reference Date
INSTRUCTIONS : Please complete the following form to the best of your ability. A rating of 9 on the 1-10 scale indi cates that the
applican t is at the 90th percentile (upper 10%); a rating of 1 places the applican t at the 10th percentile (lower 10%); a ratin g of 5places the applicant at th e 50th percentile (about the middle), etc. Any specific comments that will su pport your rating will beappreciated. Please neatly circle th e appropriate response.
PERSONA L:
1. Adapts to new situations readily. Never 1 2 3 4 5 6 7 8 9 10 Always
Never 12345678910 Always2. Projects a relaxed and confident manner when leading or working in
front of a group of peers, parents or ot her adults.
3. Accepts criticis m as information that will help in planning self-
improvement. Is not easily shaken by co mplaints of others.
Never 12345 678910 Always
4. Constantly see ks ways to improve own professional skills. Never 1 2 3 4 5 6 7 8 9 10 Always
LEADERSHIP:
5. Assumes responsibility willingly and carries out tasks efficiently. Never 1 2 3 4 5 6 7 8 9 10 Always
6. Shows competence in planning, schedul ing and managing details. Never 1 2 3 4 5 6 7 8 9 10 Always
7. Participates freely in group discussi ons of professional problems. Never 1 2 3 4 5 6 7 8 9 10 Always
8. Demonstrates ability to make decision s and to be responsible for those
decisions.
Never 12345678910 Always
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9. Shows ability to diagnose problems and gather the support of others in
solving the problem.
Never 12345678910 Always
10. Demonstrates persistence in working toward clear goals. Never 1 2 3 4 5 6 7 8 9 10 Always11. Demonstrates flexib ility in using a variety of leadership styles in
appropriate situations.
Never 12345678910 Always
12. Promotes creativity among staff. Nev er 1 2 3 4 5 6 7 8 9 10 Always13. Is well organized. Never 12 34 56 78 910 Alw ays14. Is a good self-starter and manager. Never 1 2 3 4 5 6 7 8 9 10 Always
CURRICULUM AND INSTRUCTION:
15. Participates in curriculum improvement projects. Never 1 2 3 4 5 6 7 8 9 10 Always
16. Assists staff in developing specifi c strategies for objectives. Never 1 2 3 4 5 6 7 8 9 10 Always
17. Sets high expectations for students and staff performance. Never 1 2 3 4 5 6 7 8 9 10 Always
18. Demonstrates ability to plan, implem ent and evaluate effective
edu cational programs.
Never 12345 678910 Always
19. Demonstrates awareness of need for instructional improvement. Is not
satisfied with �the way things are.�
Never 12345678910 Always
20. Possesses the understandin g and commitment to providing alternative
programs and options appropriate to stud ents with special needs.
Never 12345678910 Always
COMM UNICATION:
21. Shows ability to communicate using clear verbal illustrations and
explanations.
Never 12345678910 Always
22. Shows ability to write clearly and transmit ideas effectively on paper. Never 1 2 3 4 5 6 7 8 9 10 Always23. Facilitates open communication and understanding between school,
staff, central office and support staff.
Never 12345678910 Always
HUMAN RELATIONS:
24. Builds student self-esteem and is co urteous in working with children. Never 1 2 3 4 5 6 7 8 9 10 Always
25. Organizes the school to reflect team planning and decision making. Never 1 2 3 4 5 6 7 8 9 10 Always
26. Develops a sense of unity and common purpose among the staff. Never 1 2 3 4 5 6 7 8 9 10 Always
27. Displays loyalty to the best inte rests of the school and the school
district.
Never 12345678910 Always
28. Has demonstrated an ability to work cooperatively and productively
with others.
Never 12345678910 Always
29. Is skilled in interpersonal relation techniques. Never 1 2 3 4 5 6 7 8 9 10 Always
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30. Manages conflict productiv ely and resolves problems effectively with
parents, students and staff.
Never 12345678910 Always
31. Involves parents and community in po licy and goal setting. Never 1 2 3 4 5 6 7 8 9 10 Always32. Identifies resour ces in the community for utilization in school programs. Never 1 2 3 4 5 6 7 8 9 10 Always
33. Promotes commu nity awareness and support for school programs. Never 1 2 3 4 5 6 7 8 9 10 Alw ays34. Maintains student and staff relationships characterized by a high degr ee
of trust, support and recogn ition.
Never 12345678910 Always
35. Allows students and staff to influence policies where appropriate. Never 1 2 3 4 5 6 7 8 9 10 Always36. Maintains a friendly environment in the school. Never 1 2 3 4 5 6 7 8 9 10 Al ways
STUDENT DISCIPLINE:
37. Uses effective strategies in chan ging student behavior. Never 1 2 3 4 5 6 7 8 9 10 Always
38. Demonstrates ability to interact eff ectively with students of various
ethnic and racial backgrounds.
Never 12345678910 Always
OVERALL IMPRESSION:
39. Overall impression of the applican t�s qualifications as a potential
candidate for this position.
12 34 56 78 910
COMMENTS:
Please return this Form by mail or by fa x to the Human Resources Department.
Executive Director of Human Resources
Everett Public Schools, Human Resources Department
3715 Oakes Avenue
Everett, WA 98201
Telephone: (425) 385-4100 Fax : (425) 385-4102
Revised: 10/31/03