Reference Questionnaire

I hereby give permission to complete the following reference request furnished by Youth Encouragement Services, Inc. I understand that this information will become part of an application and is considered CONFIDENTIAL and will not be revealed to me. Please complete and submit to the YES Home.

Greetings, You are mentioned as one who is acquainted with the education and professional qualifications and character of said applicant. The applicant seeks a position as a Resident Technician/Childcare Worker at the YES Home. We ask that your respond to the following questionnaire. All information will be treated with STRICT CONFIDENCE.

Please indicate by check mark in appropriate columns your confidential rating of the applicant *
 UnsatisfactoryBelow ExpectationsSatisfactoryExceeds ExpectationsClearly OutstandingLack Basis for Evaluation
General personality
Adaptability to new ideas
Rapport with staff
Rapport with consumers
Attitude towards supervision
Follows established procedures
General professional competence
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