The Cuero Independent School District

Personnel Office

405 Park Heights Drive Cuero, TX 77954

Phone: 361-275-3832 FAX: 361-275-2981

REFERENCE FORM

Name of Applicant:___________________________ Position Applied For:_____________________

I have applied for employment with the Cuero Independent School District. I hereby authorize you to give full and complete information as requested by the Cuero ISD in compliance with the Texas Open Records Law and the Federal Educational Rights and Privacy Act of 1974. I am allowed to see this form upon written request. For your convenience, I have attached a stamped envelope addressed to the CUERO ISD PERSONNEL OFFICE, 405 PARK HEIGHTS DRIVE, CUERO, TX 77954.

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Applicant’s Signature

5-Clearly Outstanding 4-Exceeds Expectations 3-Satisfactory 2-Below Expectations 1-Unsatisfactory

5 4 3 2 1 Unknown

PERSONAL & PROFESSIONAL QUALITIES

Appearances _____ _____ _____ _____ _____ _____

Enthusiasm _____ _____ _____ _____ _____ _____

Punctuality _____ _____ _____ _____ _____ _____

Attendance _____ _____ _____ _____ _____ _____

Commitment _____ _____ _____ _____ _____ _____

Dependability _____ _____ _____ _____ _____ _____

Tact _____ _____ _____ _____ _____ _____

Loyalty _____ _____ _____ _____ _____ _____

Positive Attitude _____ _____ _____ _____ _____ _____

Professional Judgment _____ _____ _____ _____ _____ _____

Response to Supervision _____ _____ _____ _____ _____ _____

TEACHING INSTRUCTIONAL QUALITIES

Instructional Strategies _____ _____ _____ _____ _____ _____

Classroom Management & Organization _____ _____ _____ _____ _____ _____

Presentation of Subject Matter _____ _____ _____ _____ _____ _____

Learning Environment _____ _____ _____ _____ _____ _____

Professional Growth & Responsibilities _____ _____ _____ _____ _____ _____

Motivation of Students _____ _____ _____ _____ _____ _____

Attention to Student Needs _____ _____ _____ _____ _____ _____

Effective Human Relation Skills _____ _____ _____ _____ _____ _____

Peers _____ _____ _____ _____ _____ _____

Parents _____ _____ _____ _____ _____ _____

Students _____ _____ _____ _____ _____ _____

Potential for Success _____ _____ _____ _____ _____ _____

How long have you known the applicant? ___________________________________________________________

Would you hire/rehire the above applicant? _____Yes _____No

Information given above is based on (check items which apply):

_____Applicant’s Principal _____Student Teacher Under My Supervision

_____Applicant’s Assistant Principal _____Student In My Class

_____Worked Under My Supervision _____Personal Acquaintance With the Applicant

_____Co-Worker _____Other________________________________________

COMMENTS: __________________________________________________________________________________

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Signature: ____________________________________________ Position:_____________________________

Address: _____________________________________________ Date: ______________________________

THE CUERO ISD IS AN EQUAL OPPORTUNITY EMPLOYER.