St. Joseph Worker Reference Form

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Please indicate location(s) that should receive this reference. If you are unsure, please confirm location(s) with the applicant.

Los Angeles, CAOrange/Napa, CA

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Applicant's Name:

Reference’s Name:

This reference, along with the completed application packet, may be reviewed by a member of a interview committee, staff and supervisory staff at a potential service site.

1. In what capacity have you known the applicant? For how long?

2. Our Program Values are Justice, Spirituality, Leadership, and Community with Simplicity. In your experience of knowing this applicant, how is the applicant compatible with these values? Comment on the applicant’s experience of one or more of these values.

3. What are the applicant's strengths and challenges in working and/or living with others?

4. Please describe an experience in which you have seen the applicant respond to an interpersonal conflict and the applicant's style of communicating in the situation.

	Above	Average	Below	NA
Maturity

Choose the number that best fits the applicant for each characteristic below:

1 – Above Average (exceptional, overall excellent skills and strength)

2 – Average (meets expectations, usually cooperative, willing and able)

3 – Below Average (Area of concern, possible area for growth)

NA – Not Applicable (based on my experience with the applicant I am unable to evaluate in this category)

	1-Above	2-Average	3-Below	NA
Emotional stability
Ability to get along with others
Common Sense
Dependability
Tact
Ability to make decisions
Initiative
Flexibility
Ability to accept criticism
Creativity
Effective use of time
Ability to express feelings
Ability to work alone
Ability to work with others
Ability to accept supervision
Ability to work under pressure
Ability to adapt to new or unstructured situations
Ability to process and reflect on life experiences
Ability to hold confidences

Comments (Optional)

Overall, how would you describe the applicant? (Please choose one)

Highly RecommendRecommendRecommend with ReservationsDo Not Recommend

Is there anything else about this candidate that you would like to share?

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Date (MM/DD/YYYY)

Occupation/Title

Phone

Address

City

State

Postal Code

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