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Blank Personal Refrence

The document is a personal reference form for individuals applying to work in child day care centers and school age child care programs in New York State. It includes questions about the applicant's relationship with children, their caregiving abilities, and the reference's personal observations. The form requires the reference to provide their contact information and comments regarding the applicant's suitability for working with children.

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82 views2 pages

Blank Personal Refrence

The document is a personal reference form for individuals applying to work in child day care centers and school age child care programs in New York State. It includes questions about the applicant's relationship with children, their caregiving abilities, and the reference's personal observations. The form requires the reference to provide their contact information and comments regarding the applicant's suitability for working with children.

Uploaded by

info
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES

Personal Reference
Child Day Care Centers and School Age Child Care Programs

Personal Reference For:

The above named person has applied to become a [ of a [ program and has given you as
an personal reference.

Please answer the following questions in regard to [ ]’s abilities to care for children,
and return to them for inclusion in their application packet. Feel free to add any comments of your own.

• How long have you known the above person named


person?
• When is the last time you had contact with
them?
• What is the nature of your
relationship?
• Have you ever observed them when s/he has been providing care for young children? ☐ Yes ☐ No
• How would you describe their relationship with his/her own
children?

• Would you place your child in their care? ☐ Yes ☐ No Please explain why or why not:

• Is there any reason to believe that they should not be working with children (family situation, etc.)
☐ Yes ☐ No Please explain why or why not:

• Using the following scale – (1) Excellent; (2) Good; (3) Poor; (4) Unknown – describe their ability to:
Provide a safe and loving
Cooperate with others Communicate Effectively environment
Be dependable Appropriately discipline children

• Other Comments

Name: Title:
Please Print

Signature: Date:

Phone: ( ) Hours Available:

Address:

City: State: Zip:


If you have any questions or need assistance, please feel free to call [case_worker's_name] at
[case_worker's_phone_number}.

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