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Learn, Grow, Go

SERVICES, CARE, AND SUPPORT
EMPLOYMENT
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NEW HIRE REFERENCE

Applicant/Employee Name

Person Providing Reference For Employee (what is your name?)

Phone

Approximately how long have you known the applicant/employee?

How do you know the applicant? * Required

Currently Work With

Previously Worked With

Supervised

Friend

Do you have any concerns for the employee/applicant with providing care to adults and/or minors?

Please explain ONLY if you have concerns with this employee/applicant providing care to adults and/or minors?

If the applicant was a former employee, would you rehire this person?

What qualities would you mark that the applicant/employee has for working with adults and/or minors with disabilities? Check all that apply. * Required

Patience

Calmness

Observant

Helpful

Empathy

Optimism

Kindness

Understanding

Responsive

Adaptable

Professional

Communicative

Persons signature providing reference (please type)

Thanks for submitting!

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