Easter Seals Wisconsin AmeriCorps Reference Form

Submitted by ngarrett on Fri, 2010-05-07 09:12

Applicants: Please forward this link to at least two references. You will not receive a confirmation upon its completion; it is your responsibility to follow up with your reference to ensure its submission.

References: An applicant has requested your reference in applying for an AmeriCorps position with Easter Seals Wisconsin. AmeriCorps is a national service program providing over 75,000 citizens with opportunities to serve their community each year to meet critical needs. By partnering with the AmeriCorps program, Easter Seals Wisconsin is able to offer new and expanded services such as respite care for families, therapeutic recreation, assistance for farmers with disabilities, vocational resources, outreach, community education and much more. Selecting the right AmeriCorps members to provide these services is not an easy task. Please consider your reference to be a vital part of our selection process. Your statements regarding this applicant will be disclosed only to the people making the hiring decisions. If you have any questions, please call 608-277-8288 ext 126. Thank you for your time!

Easter Seals Wisconsin is an Equal Opportunity Employer (EOE) and does not discriminate on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, political affiliation, military service or marital or parental status.

Applicant Name: *

Your Name: *

May we reach you for follow-up on this applicant?: *

Yes

If yes, please enter your phone number (for follow-up questions only).:

How long have you known the applicant and in what capacity?: *

Work Performance

Please comment on the applicant's dependability, initiative and ability to work as a team member and with minimal supervision.: *

Relationships with Others

Please comment on the applicant's relationships with others of varied backgrounds (cultural, racial, educational, etc.).: *

Emotional Maturity

Please comment on the applicant's ability to adapt to work under difficult and changing conditions.: *

Do you know of any reason that would make this applicant unsuitable for working with individuals with disabilities?: *

Any additional comments and/or supporting information you can provide (e.g. special skills, reservations, etc.) is appreciated.:

Overall Recommedation

What is your overall recommendation?: *

I recommend the applicant for AmeriCorps service.

I have some reservations, but I believe the applicant will succeed in serving with AmeriCorps.

I do not recommend this applicant for AmeriCorps service.

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