Reference for Employment

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URL

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Transformations Hope for Today’s Families LLC 4010 Dupont Circle Suite 582, Louisville, KY 40207, has received an application for employment and a signed authorization for you to provide a reference for employment. Employers are eligible to provide this informations per KRS 411.225.

Your response is appreciated.

Applicant Name*

Please provide the name of the applicant requesting your reference.

First Last

How long have you known this person?

Employers may provide the dates of employment.

Are you aware of any problems such as alcoholism, drug abuse, physical or sexual abuse, arrest record, or other problems in the applicant’s background that might interfere with performing work dutues.

Yes

If yes, please explain.

In your judgement, is this person a dependable, honest and stable person?

Yes

Comments:

Please give your impression of the applicant. Include your observations of the relationship of the applicant with co-workers, clients, supervisors, etc., depending on the capapcity which you know the applicant.

Please give your impression of the applicant’s readiness for the above named position, keeping in mind that they will be working with vulnerable adults, children and families with behavioral and emotional disturbances.

Please give your impression of the applicant’s ability to complete documentation and paper work in a thorough and timely manner.

Please share any comments or concerns you have regarding this applicant.

Signature of Person Providing this Reference.*

Name of Person Providing this Reference.*

First Last

Your Relationship to the Applicant*

Please indiccate your title and if you are a licensing supervisor, work supervisor, employer, professor, a co-worker, personal reference or other.

Name of Organization/Business (if applicable).

Address of Person or Organization Providing the Reference.*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email Address*

Date of Signature*