Classified Application - Reference Form

CLASSIFIED REFERENCE FORM

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Print Applicant NamePosition(s) Applied For

I hereby give you permission to complete and release this reference form to Dayton Independent Schools. I agree that the information requested will become a part of my personnel file as an applicant or employee of the Dayton Board of Education. I agree that the information will not be disclosed to me, but is to be treated as confidential by the Dayton Board of Education. I waive my right to see this information. I further release and agree to hold harmless the Dayton Board of Education and the persons and/or legal entities completing the reference form from any and all claims, demands, actions, and causes of actions which I might have resulting or to result from the furnishing or utilization of the information requested and/or provided.

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Signature of ApplicantSocial Security NumberDate

CONFIDENTIAL

The above named person has filed an application for employment with the Dayton Independent Schools. In completing the application, the applicant has indicated that you may be able to help us in evaluating his/her potential as an employee.

Please complete the inquiry on the reverse side of this letter. Add any comments you may care to make. The above applicant cannot be considered for employment until the application is complete and their references are part of the application. Your cooperation and promptness in returning this inquiry to us will be greatly appreciated.

Sincerely,

Dayton Independent Schools

200 Clay Street

Dayton, KY41074

Phone…859-491-6565

Fax…859-292-3995

Please complete other side.

File: Classified Reference Form - Revised Nov, 2002

OFFICIAL CONFIDENTIAL INFORMATION

Based on your experience, please rate the applicant as follows:

Please indicate by checking  / Outstanding / Above
Average / Average / Fair / Below
Average / Unknown
Acceptance of constructive supervision
Attitude toward work
Cooperation with co-workers
Maturity in social and intellectual areas
Participation in school and community activities
Personal appearance
Professional reliability and attitude
Punctuality
Regularity of attendance
Responsibility in areas of morality
Use of English

How long have you known applicant? ______

Would you recommend employment of the applicant?

 Yes  Without reservation  With reservationCannot recommend

Explain:

Would you want this person to work with YOUR CHILD in an educational setting (if applicable to position)?

 Yes  No  Not Applicable

Information given above is based on (check all items that apply):

 Personal acquaintance with applicant Worked under my supervision

 A co-worker Former student

Remarks:

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Company NameSignature

Street Print Name & Title

City/State/Zip Phone

File: Classified Reference Form - Revised Nov, 2002