Get You Have Been Given As A Reference Person Who Could Help This Licensing Agency Establish Whether

This guide will assist you in completing the form titled 'You Have Been Given As A Reference Person Who Could Help This Licensing Agency Establish Whether.' By following these steps, you will provide valuable insights that the licensing agency requires. Your input is essential for ensuring a high quality of care in community facilities.

Follow the steps to complete the reference request form accurately.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Fill in the date in the designated space at the top of the form.
3. Enter the facility name and facility number in the appropriate fields. This information identifies the location associated with the licensing request.
4. Provide the applicant’s name clearly in the specified area to indicate whose qualifications you are assessing.
5. Detail the type of persons served by the facility, ensuring it reflects the demographics and needs of individuals receiving care.
6. Indicate the type of facility being referenced, such as a group home, adult care center, etc.
7. Specify the requested capacity to help the agency understand the scale of care the applicant is expected to manage.
8. Respond to the questions on the form thoroughly. Start with whether any physical or emotional limitations could affect the applicant’s performance. Provide specific examples or incidents.
9. Evaluate the applicant's understanding, warmth, and ability to provide quality care. Expand on your response with reasoning.
10. Assess the applicant’s education, experience, and maturity in relation to the position.
11. Share your insights on the applicant's honesty and integrity.
12. Evaluate the applicant’s capability to supervise staff, providing specific explanations.
13. Comment on the applicant's business and financial experience relevant to the position.
14. Reflect on whether you would place a close relative with this applicant for care, explaining your reasoning.
15. Indicate your recommendation for the applicant by selecting 'Yes' or 'No' and provide additional comments as necessary.
16. Complete the section detailing your relationship to the applicant and how long you have known them.
17. Sign and date the form to certify the information provided.
18. If needed, attach an additional sheet for more space and ensure all responses are complete before submission.

Submit your completed form online to assist the licensing agency in their evaluation.