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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| 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)
| | | | | | | | | | | | |
| 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 completed form to Human Resources:
Email:
Employmentsrv@everettsd.org
Fax: 425-385-4102
Mail:3900 Broadway, Everett, WA 98201
Revised: 02/18/2016
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