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OFFICE USE ONLY Signature of Evaluator PBSD 0606 Rev. 7/24/2013 Date Time Per Florida Statute 119 this form will be shown to applicant and other members of the public only upon specific request. THE SCHOOL DISTRICT OF PALM BEACH COUNTY/ DIVISION OF HUMAN RESOURCES Applicant ID 3300 Forest Hill Blvd. A-132 West Palm Beach FL 33406 Tel* 561-434-8430 Fax 561-434-8561 Employment Reference The applicant has applied for a position with the School District of Palm Beach County and has listed you as a reference. This reference form will be included in the applicant s file for review by the appropriate supervisor. Return the completed form to the applicant or fax or mail to the above number/address. Falsifying this document will result in a ban from employment eligibility with the District for one year. Print and use blue or black ink. SECTION I Applicant Name Evaluator Name Evaluator Title I authorize you to provide the Palm Beach County School District with information regarding my suitability for employment. Note all references will be verified by Human Resources. Company/School Address Direct Phone E-mail Signature of Applicant SECTION III TO BE COMPLETED BY EVALUATOR I have known the applicant check one Current Employer Former Employer Co-worker PROFESSIONAL TRAITS Excellent Student Good Volunteer Average Professional Personally Below Average Unacceptable Not Applicable Dependability/Reliability Attendance/Punctually Ability to Work with Others Ability to Accept Criticism Judgment/Common Sense Language and Communication Skills Overall Job Performance TEACHING TRAITS Enthusiasm for Teaching Knowledge of Subject Matter Lesson Planning/Preparation Sensitivity to Individual Student Needs Student Response to Teaching Classroom Management Discipline Employment dates or length of time you have known the applicant Would you consider hiring rehiring the applicant Yes From No / To Position/ job title when employed Would you approve hiring rehiring the applicant as a substitute teacher Does company policy prohibit rehiring Not Applicable Were any disciplinary actions initiated with this applicant If yes provide information below If former employee why did the applicant leave your employ Provide any additional information on the applicant we may need to know as a prospective employer. THE SCHOOL DISTRICT OF PALM BEACH COUNTY/ DIVISION OF HUMAN RESOURCES Applicant ID 3300 Forest Hill Blvd. A-132 West Palm Beach FL 33406 Tel* 561-434-8430 Fax 561-434-8561 Employment Reference The applicant has applied for a position with the School District of Palm Beach County and has listed you as a reference. A-132 West Palm Beach FL 33406 Tel* 561-434-8430 Fax 561-434-8561 Employment Reference The applicant has applied for a position with the School District of Palm Beach County and has listed you as a reference. This reference form will be included in the applicant s file for review by the appropriate supervisor. This reference form will be included in the applicant s file for review by the appropriate supervisor. Return the completed form to the applicant or fax or mail to the above number/address. Falsifying this document will result in a ban from employment eligibility with the District for one year.