Child Day Care - Staff Application Fee Form Page 7
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12Connecticut Office of Early Childhood
Division of Licensing
Return to:
Connecticut Office of Early Childhood -Family Day Care-Application Unit
410 Capitol Ave. MS#12 CBR - P.O. Box 340308
Hartford, CT 06134-0308
REQUEST FOR REFERENCE
Regarding the following person:
Who is an applicant for the position of:
name
Main child caregiver in a Family Day Care Home
address
town, zip state
Substitute
Assistant caregiver in Family Day Care Home
or
Please answer the following questions:
l
How long have you known the applicant? (What period of time?)_____________________
In what capacity? (relative? friend? employer? caregiver? neighbor?__________________
How well do you know the applicant?___________________________________________
2
Is the applicant physically and emotionally capable of providing responsible child care?
COMMENTS:
3
Is the applicant able to provide reliable and consistent child care?
COMMENTS:
4
Is the applicant able to provide adequate and nutritious meals and snacks?
COMMENTS:
5
Is the applicant able to deal with emergencies in a calm manner?
COMMENTS:
6
Have you observed this person handling children’s problem behaviors?
How were the children treated?
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