2. Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Organization*
14. Applicant Name (first & last)*
16. I have known this applicant*
    -- Select One --PersonallyProfessionally
18. Name of organization where applicant was employed:*
20. Position of job title of the applicant when employed:*
22. Length of time you have know this applicant:*
24. Is Dependable of punctual*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
25. Shows Initiative*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
27. Follows Written & Oral Instructions Well*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
28. Performs Well without the Need of Direct Supervision*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
30. Has Good Rapport with Colleagues*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
31. Demonstrates Good Overall Job Knowledge*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
33. Maintains Professional Appearance*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
34. Exhibits Ethical/Professional Behavior*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
36. Utilizes Effective Written and Oral Communication Skills*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
37. Demonstrates Good Judgement*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
39. Performs High Quality Work*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
40. Seeks Professional Growth Opportunities*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
42. Demonstrates Flexibility in the Work Environment*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
46. Instruction (If Applicable)
48. Prepares Engaging Lessons*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
49. Demonstrates Thorough & Effective Planning*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
51. Maintains Discipline Appropriately *

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
52. Shows Mastery of Subject Area*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
54. Is Willing to Experiment. Try new Methods & Apply Educational Research *

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
55. Adapts to Student's Individual Differences*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
57. Communicates Effectively with Parents*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
58. Uses Appropriate Technology in the Work Environment*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
60. Uses Appropriate Methods of Student Assessment*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
61. Has Awareness of Larger Institutional Goals*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
63. Has Good Rapport with Students*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
64. Is Committed to Student Success*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
66. Has a Passion for Teaching and Learning*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Meets/Met acceptable standards
67. Participates in Extra Activities such as Committees, Etc.*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
71. Leadership (If Applicable)
73. Demonstrates Effective Leadership Qualities*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
74. Has High Expectations of Employees*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
76. Possesses High Problem Solving Skills*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
77. Is Willing to Experiment and Try New Methods*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
79. Hires Highly Effective Personnel*

    1. No basis for judgement
    2. Below acceptable standards
    3. Good
    4. Meets/Met acceptable standards
    5. Outstanding
81. I have personally completed this form and returning it without revealing its contents to applicant*
83. Date*
    Date
85. Title (If applicable)*
87. Indicate your overall recommendation of this applicant*
    -- Select One --Below ExpectationsMeets ExpectationsExceeds Expectations
89. Please check one of the following*

    1. I have additional information about the applicant which I believe should be shared with Oakland Avenue Charter School. Please have the appropriate school administrator call me.
    2. The above reference is, to the best of my knowledge, an accurate reflection of the candidate ability and his/her traits.
91. Do you know of any reason why this person should not work around children?*

    1. Yes
    2. No
93. If yes, please elaborate:
Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit

* indicates a required field