1. SECTION 1 - TO BE COMPLETED BY APPLICANT
      2. SECTION 2 - TO BE COMPLETED BY CURRENT AND / OR PAST SUPERVISOR
      3. EVALUATION:
      4. On a scale of 0 – 4 how would you rate the applicant’s job performance?
      5.        
      6. PLEASE COMPLETE FOR ALL APPLICANTS:
      7. PLEASE COMPLETE IN REGARD TO TEACHER APPLICANTS ONLY:


      Everett Public Schools

      Applicant Reference Form


       

      NOTE TO APPLICANT: It is YOUR responsibility to distribute this Form to current and/or past supervisor(s).

      Please complete Section 1 and then forward to the individual you have selected to provide your confidential reference .





      SECTION 1 - TO BE COMPLETED BY APPLICANT

      I, ­­­­­­­­­­­­­­­­­­­­_______________________am an applicant with the Everett Public Schools. Please state frankly your opinion of my abilities on the form below. Thank you for your assistance.

      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.

       

      _____________________________________________

      Signature of Applicant

       





      SECTION 2 - TO BE COMPLETED BY CURRENT AND / OR PAST SUPERVISOR

      What was your title at the time you worked with this applicant?

      _____________________________ __________________________________________

        (Title)          (Company Name / School District)

       

      From: _____________________   To:__________________________

      (Date) (Date)

       





      EVALUATION:

      How long have you known this applicant? _________________________________________________

      Applicant’s reason for leaving this position: _________________________________________________

      In what capacity do you know this person? _________________________________________________

      Is this Applicant eligible for re-employment? _________________________________________________





      On a scale of 0 – 4 how would you rate the applicant’s job performance?





                   





      PLEASE COMPLETE FOR ALL APPLICANTS:

      0 – Not observed 1 – Does Not Meet Expectations 2 – Below Expectations 3 – Fully Meets Expectations 4 – Exceeds Expectations
       0 1 2 3 4
      Understands assigned tasks      
      Utilizes effective oral and written communication      
      Uses professional judgment      
      Collaborates with co-workers, administrators and supervisors      
      Develops positive relationships with students      
      Develops positive relationships with co-workers and supervisors      
      Uses sick or personal leave appropriately      
      Demonstrates organizational skills      
      Demonstrates punctuality      
      Exhibits creativity and resourcefulness      
      Maintains a flexible and positive attitude      




       
       0 1 2 3 4
      Manages work assignments effectively      
      Exhibits dependability      
      Accepts additional responsibilities      
      Understands / appreciates multicultural and diverse populations      
      Displays positive behavior management / discipline strategies      
      Demonstrates technological literacy      


         





      PLEASE COMPLETE IN REGARD TO TEACHER APPLICANTS ONLY:

      0 – Not observed 1 – Does Not Meet Expectations 2 – Below Expectations 3 – Fully Meets Expectations 4 – Exceeds Expectations
       0 1 2 3 4
      Exhibits good teaching strategies      
      Has knowledge of subject matter      
      Uses effective classroom management techniques      
      Utilizes formative and summative assessments      
      Commitment to student achievement      
      Plans for instruction      


       

      Areas of Strength __________________________________________________________________________

       

      _________________________________________________________________________________________________

       

      Areas that need improvement ___________________________________________________________________

       

      _________________________________________________________________________________________________

       

      Has this person ever received a letter of direction or reprimand? ____Y____ N ____ Not Applicable / Unknown

      Did the employer ever consider taking action to demote, suspend, non-renew,

      or dismiss the employee? ___ Y ___ N ___ Not Applicable / Unknown

      Was this person ever involved in an incident that resulted in injury to a student

      or co-worker? ___ Y___ N ___ Not Applicable / Unknown

      Would you want this person supervising / working with your child or children you know well? ___ Y ___ N

      If you had an opening in a similar position, would you employ this person? __ Y ___ N

       

      Comments: _________________________________________________________________________

       

      ___________________________________________________________________________________

       

       

      Name: _____________________________________ Signature: _________________________

      Organization: ________________________________ Position/Title: ____________________________

      Date Reference Completed: _____________ Phone Number: ____________________


       

      Please return this completed form to Human Resources:

      Email: Employmentsrv@everettsd.org  

      Fax: 425-385-4102

      Mail:3900 Broadway, Everett, WA 98201

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