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