Aall Reasonable Efforts

REFERENCE FORM

Applicant’s Name: (applicant's name) Date: (date) How long have you known the applicant?: (length of time) In what capacity? (how do you know the applicant) Has the applicant worked for you? Yes No Position held: (position held) Quality of work? (quality of work) Reason for leaving: (reason for leaving) If you were selecting personnel for a position, would you employ this applicant? Yes No

PLEASE COMPLETE THE FOLLOWING: Personal Characteristics: Industry - Is punctual, accurate, thorough, persevering, can carry heavy work load. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Ethical Habits: Is dependable, loyal, sincere, fair, and honest. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Appearance and Grooming: Is neat, clean, dresses appropriately for job. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Personal Conduct: Has a high standard of morals and good manners. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Health: Maintains good physical and mental health. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Outlook on Life: Have enthusiasm, optimism and vision. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Resourcefulness: Is self reliant, has initiative and qualities of leadership. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Intelligence: Is mentally alert, has capacity for growth. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Attitude and Relationships: Attitude toward people; is friendly, tolerant, and tactful. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Relationships with People: Cooperates and maintains wholesome relationships with others. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Abilities: To analyze problems and make plans. To follow through and execute plans. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN To write effectively with clarity and forcefulness. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN To teach effectively. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN To work with others. EXCELLENT VERY GOOD GOOD FAIR POOR UNKNOWN Referral Information (continued) - Personal Characteristics Please give additional information which will help in determining the applicant’s ability to carry on an educational program through the Cooperative Extension Service.

(additional information)

______Signed

______Position