DISTRICT REFERENCE FORM FOR ADMINISTRATIVE POSITIONS
EVERETT PUBLIC SCHOOLS
REFERENCE FORM FOR ADMINISTRATIVE POSITIONS
NOTE TO APPLICANT: Please complete Section 1 and then forward to your current and/or past supervisor(s).
SECTION 1 – TO BE COMPLETED BY APPLICANT
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| I, _________________________________________, am an applicant with the Everett Public Schools for an administrative position.
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| Please state frankly your opinion of my abilities on the form below. Thank you for your assistance.
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I hereby authorize Everett Public Schools to conduct reference checks to obtain information relating to my application of employment with no liability arising therefrom. I am advised that the reference checks may include information on my character, general reputation and personal characteristics as they may relate to my ability to perform the job for which I am applying.
__________________________________________________ ___________________________________________
SECTION 2 – TO BE COMPLETED BY CURRENT AND/OR PAST SUPERVISOR
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| ______________________________________
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| ______________________________ |
| ____________________________ |
| Print name of person completing reference
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| Title Telephone Number |
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| _________________________________________________________________________
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| ____________________________ |
| Working relationship with applicant
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|
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| _________________________________________________________________________
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| ____________________________ |
| Signature of person completing reference
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INSTRUCTIONS: Please complete the following form to the best of your ability. A rating of 9 on the 1-10 scale indicates that the applicant is at the 90th percentile (upper 10%); a rating of 1 places the applicant at the 10th percentile (lower 10%); a rating of 5 places the applicant at the 50th percentile (about the middle), etc. Any specific comments that will support your rating will be appreciated. Please neatly circle the appropriate response.
| 1.
| Adapts to new situations readily.
| Never
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| 9
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| Always
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| 2.
| Projects a relaxed and confident manner when leading or working in front of a group of peers, parents or other adults.
| Never
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| Always
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| 3.
| Accepts criticism as information that will help in planning self-improvement. Is not easily shaken by complaints of others.
| Never
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| Always
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| 4.
| Constantly seeks ways to improve own professional skills.
| Never
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| Always
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5.
| Assumes responsibility willingly and carries out tasks efficiently.
| Never
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| Always
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6.
| Shows competence in planning, scheduling and managing details.
| Never
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| Always
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7.
| Participates freely in group discussions of professional problems.
| Never
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| Always
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8.
| Demonstrates ability to make decisions and to be responsible for those decisions.
| Never
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| Always
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9.
| Shows ability to diagnose problems and gather the support of others in solving the problem.
| Never
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| Always
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10.
| Demonstrates persistence in working toward clear goals.
| Never
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| Always
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11.
| Demonstrates flexibility in using a variety of leadership styles in appropriate situations.
| Never
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| Always
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12.
| Promotes creativity among staff.
| Never
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| Always
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13.
| Is well organized.
| Never
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| Always
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14.
| Is a good self-starter and manager.
| Never
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| Always
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| CURRICULUM AND INSTRUCTION:
| (If applicable)
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15.
| Participates in curriculum improvement projects.
| Never
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| Always
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16.
| Assists staff in developing specific strategies for objectives.
| Never
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| Always
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17.
| Sets high expectations for students and staff performance.
| Never
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| Always
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18.
| Demonstrates ability to plan, implement and evaluate effective educational programs.
| Never
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| Always
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19.
| Demonstrates awareness of need for instructional improvement. Is not satisfied with “the way things are.”
| Never
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| Always
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20.
| Possesses the understanding and commitment to providing alternative programs and options appropriate to students with special needs.
| Never
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| Always
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21.
| Shows ability to communicate using clear verbal illustrations and explanations.
| Never
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| Always
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22.
| Shows ability to write clearly and transmit ideas effectively on paper.
| Never
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| Always
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23.
| Facilitates open communication and understanding between school, staff, central office and support staff.
| Never
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| Always
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| 24.
| Builds student self-esteem and is courteous in working with children.
| Never
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| Always
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| 25.
| Organizes the school to reflect team planning and decision making.
| Never
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| Always
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| 26.
| Develops a sense of unity and common purpose among the staff.
| Never
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| Always
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| 27.
| Displays loyalty to the best interests of the school and the school district.
| Never
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| Always
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| 28.
| Has demonstrated an ability to work cooperatively and productively with others.
| Never
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| Always
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| 29.
| Is skilled in interpersonal relation techniques.
| Never
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| Always
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| 30.
| Manages conflict productively and resolves problems effectively with parents, students and / or staff.
| Never
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| Always
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| 31.
| Involves others in policy and goal setting.
| Never
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| Always
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| 32.
| Identifies resources for programs.
| Never
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| Always
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| 33.
| Promotes community awareness and support for programs.
| Never
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| Always
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| 34.
| Maintains relationships characterized by a high degree of trust, support and recognition.
| Never
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| Always
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| 35.
| Allows others to influence policies where appropriate.
| Never
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| Always
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| 36.
| Maintains a friendly environment.
| Never
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| Always
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| STUDENT DISCIPLINE:
| (If applicable)
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| 37.
| Uses effective strategies in changing student behavior.
| Never
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| Always
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| 38.
| Demonstrates ability to interact effectively with students of various ethnic and racial backgrounds.
| Never
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| Always
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| 39.
| Overall impression of the applicant’s qualifications as a potential candidate for this position.
| | 1
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Please return this Form by mail or by fax to the Human Resources Department.
Executive Director of Human Resources
Everett Public Schools, Human Resources Department
3900 Broadway
Everett, WA 98201
Telephone: (425) 385-4100 Fax: (425) 385-4102
Revised: 1/12/06
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