Reference Form
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1The School Board of Broward County, Florida
Instructional Staffing Department
600 Southeast Third Avenue, Fort Lauderdale, Florida 33301
Phone (754) 321-2320 FAX (754) 321-2716
R
F
EFERENCE
ORM
Teacher Application Reference
Substitute Teacher Application
Section I: To be completed by the Applicant
(Last Four Digits Only)
Applicant's Name:
Social Security Number: XXX-XX-____ ____ ____ ____
has applied for an instructional position in the following area/s:
Section II: To be completed by the Evaluator
I have known this applicant:
as a student
as an employee
personally
as a co-worker
Dates of employment or length of time you have known
CLASSROOM MANAGEMENT
the applicant (mm/yr):
From ____ / ________ to ____ / ________
ABILITY TO PLAN AND ORGANIZE
Position or job title of the applicant when employed:
USES GOOD JUDGEMENT
__________________________________________________
SENSITIVITY TO OTHERS
Your title at the time you supervised the applicant:
SHOWS LEADERSHIP
(If applicable)
SHOWS INITIATIVE
__________________________________________________
DECISION MAKING SKILLS
Do you know of any reason why it would not be advisable
for this individual to be employed in a capacity where he/she
TOLERANCE FOR STRESS
would come in contact with children? Yes
No
If yes, please explain: _____________________________
COMMUNICATION SKILLS
/
ADAPTABILITY
COOPERATION
I would employ or reemploy this individual:
Yes
No
OVERALL JOB PERFORMANCE
A
C
: ______________________________
DDITIONAL
OMMENTS
Please include a phone and fax number where you can be reached to verify this reference.
Phone: (
)
Fax: (
)_______________________________________
School/Company Name: _________________________________ Date: ____________________________________________
Address: _________________________________________________________________________________________________
Evaluator’s Signature:
Print Name: _____________________________________________
This form will be shown to the applicant or other members of the public only upon specific request, in compliance with Florida Statute 119, Public
Records Laws.
Form Revised 12/09
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Parent category: Letters