NEWTON COUNTY SCHOOLS

REFERENCE FORM
has applied for the position of
You may be assured that your evaluation of the applicant and other information will be treated con
and used in a professional manner. If you have questions regarding this form you may contact Huma
at the number listed within the Job Center "Contact Us" page. Thank you.

Please record in the box to the right of each item a number from 1 to 5 from the scale below to show how you ra
1 = Outstanding (Top 10%) 2 = Above Average (Top 25%) 3 = Avera
4 = Below Average (Bottom 25%) 5 = Not Observed
Commitment/Enthusiasm 1 Works Independently/Self-Disciplined
Maturity (Poise, Self-Control) 1 Communicates Effectively with Parents
Physical Fitness & Health 3 Relates Well to Co-Workers
Initiative/Self-Confidence 2 Correct Use of Standard English (Writing & Speakin
Punctuality 1 Instructional Management Skills
Attendance 1 Teacher Candidates Only
Positive Attitude 2 Instructional Planning
Efficiency in Routine Matters 1 Assesses Student Needs & Implements Instructional Plan
Flexibility 1 Evaluation of Student Progress
Professional Appearance 1 Development of a Conducive Learning Environmen
Loyalty/Support of School & System 1 Motivates & Relates Well to Students
Accepts Constructive Criticism 2 Classroom Management Skills
Overall R

If the candidate is applying for other certified non-teaching position(s), please comment on ap
you have observed:
Yes No Please check "yes" or "no" in the box to the left of the ques
x Does this applicant accept extra duties willingly?
x Is this a person you would like to have teach or supervise your child or a child to whom you are
x Would you prefer talking by telephone about this person and his/her performance record?
To your knowledge, has this person ever failed to have contract renewed, resigned to avoid be
x or been fired from employment?
x Would you re-employ this applicant in such position as listed above?

In what capacity and for how long have you known this applicant? Employer 1 year

Date of employment/relationship: From Jan. 2008 To

Do you know of any reason why Newton County Schools should not employ this applicant?
No.

Comments:
Outstanding employee, very dependable and reliable.

Name: Venessa Bines-Truitt Position: Head Counselor, Sequoyah Mid

Signature:Venessa Bines-Truitt Date: 6/22/2010
 NEWTON COUNTY SCHOOLS
REFERENCE FORM

treated confidentially
ntact Human Resources
ou.

how you rate this applicant.

3 = Average (Middle 50%)

1
1
1
g & Speaking) 1
t Skills 1
nly

ctional Plan

Environment
1

Overall Rating:

ment on appropriate skills

the questions

hom you are very close?

ecord?
to avoid being terminated

r 1 year

Mar. 2009

uoyah Middle School DCSS