INDIANA UNITED METHODIST CHILDREN'S HOME, INC.


Reference Check Sheet


Applicant's Name:

Position:

The above named person has applied to Indiana United Methodist Children's Home for the position indicated. Because of our work with emotionally disturbed children, it is imperative we have people on our staff who are reliable, caring and industrious. We would appreciate your help in providing the information requested.


  Michael J. Waggoner, ACSW, LCSW
Interim Executive Director



I am answering as: Personal Reference   Former/Current Employer or Supervisor

If you have employed this person, would you re-employ?  Yes   No   Not previously employed
If no, please explain:

Please rate applicant, in your opinion, on the following:

Not
Observed		 Excellent Above
Average		 Average Below
Average		 Poor
Character, honesty, integrity
Dependability
Ability to get along with others
Adaptability to new situations
Judgment
Alertness
Eagerness to Learn
Cooperation, loyalty
Initiative, Resourcefulness
Ability to take and follow directions
Competence, skill for position
Ability to work with children

Remarks:


Submission Date: Sun Aug 1, 2010 Name of person giving reference: