Confidential Employee Reference Request
We have received an application from one of your colleagues/former colleagues for a FILLINHERE teaching position at FILLINHERE School. We appreciate your assistance in providing the following information about the candidate.
Would you prefer to attach another confidential reference that you may have on file in place of filling out this form?*
Yes No
Please attach your confidential reference here
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Date that the reference was completed*
Month Day Year
Date
Name of employee*
First Name Last Name
Section of the school the applicant is applying for*
Lower School Upper School Schoolwide
What position did the applicant occupy when you worked with them?*
When did you start working with this candidate?
Day Month Year
Date
How long did you work with the candidate?*
Please select the most appropriate rating for each of the following:
1. Ability to communicate effectively*
1 2 3 4
1 is Lowest, 4 is Highest
2. Knowledge of curriculum content*
1 2 3 4
1 is Lowest, 4 is Highest
3. Knowledge of pedagogy and effective instructional strategies*
1 2 3 4
1 is Lowest, 4 is Highest
4. Use of data for self-reflection and future planning*
1 2 3 4
1 is Lowest, 4 is Highest
5. Ability to foster caring and respectful interactions with students*
1 2 3 4
1 is Lowest, 4 is Highest
6. Ability to provide a challenging and dynamic learning environment*
1 2 3 4
1 is Lowest, 4 is Highest
7. Ability to set and manage behaviour expectations*
1 2 3 4
1 is Lowest, 4 is Highest
8. Use a variety of strategies and resources for teaching and assessment*
1 2 3 4
1 is Lowest, 4 is Highest
9. Appropriate use of technology*
1 2 3 4
1 is Lowest, 4 is Highest
10. Contribution to the professional climate of the School*
1 2 3 4
1 is Lowest, 4 is Highest
11. Proactiveness in his/her own professional growth*
1 2 3 4
1 is Lowest, 4 is Highest
12. Sense of organization and order*
1 2 3 4
1 is Lowest, 4 is Highest
13. Relationships with parents*
1 2 3 4
1 is Lowest, 4 is Highest
14. Relationships and collaboration with colleagues*
1 2 3 4
1 is Lowest, 4 is Highest
15. Effective contribution to school life beyond the classroom*
1 2 3 4
1 is Lowest, 4 is Highest
On a scale of 1 to 10 (low to high), how would you compare the applicant to other employees you have supervised or worked with in similar positions?*
In what areas would you like to see this candidate improve?*
Please explain why you would recommend this candidate.*
Do you have any concerns about the candidate working unattended with children?*
Yes No
Are there any unresolved matters concerning child safeguarding allegations?*
Yes No
Would you wish your school to retain or re-employ this candidate?*
Yes No
Referee Information
Please enter your name*
First Name Last Name
In what capacity did you work with the applicant?*
Please input your email address to receive a copy of this reference*
example@example.com
Should be Empty:

Confidential Employee Reference Request

Please select the most appropriate rating for each of the following:

Referee Information