Employer Referencegreg2016-08-06T18:09:05+02:00 We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Confidential Reference for Name of Applicant Please be as objective as possible in your evaluation of the applicant. This reference will be most valuable to us when completed as honestly as possible by someone who knows the applicant well. Your response and comments will be helpful in the evaluation of the applicant and will remain confidential. To be completed by the person providing the reference: Your Name Prefix First Last Suffix Your Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Your Phone Number In what capacity have you known the applicant? Supervisor Colleague Friend How many years have you known the applicant? How well would you say you know the applicant? Check all that apply. Work only Socially Not very well Casually Very well What level of communication have you had with the applicant in the past 6 months? None Surface Personal Very personal Please mark the statement in each category that most accurately describes the applicant. 1. Social Acceptability Generally avoided Liked by some/Slow to make friends Liked by most/Makes friends easily Very popular 2. Family Relationships Stable and supportive Stable but not supportive Unstable but supportive Unstable and not supportive 3. Social Manners Awkward in social situations Average Well mannered Socially adept 4. Relationships with the Opposite Sex or Spouse Insensitive/inconsiderate/inappropriate Sensitive and considerate but awkwards Feels at ease Relates very well 5. Response to Pressure and/or Ambiguity Withdraws socially and emotionally Becomes overly critical of others Dominates situations and/or people Adapts after time Copes well 6. Self-Assurance Insecure Needs encouragement Average Confident Very self-assured 7. Ability to Work Under Authority Rebellious Independent Spirit Average Cooperative Very cooperative 8. Working with Peers Often has problems relating to others Sometimes has difficulty interacting with others Average ability to work with others Able to work well with others 9. People/Task Orientation Task/Goal oriented People/Relationship oriented Balanced between the two 10. Works Well Alone On a Team Equally either on a team or alone 11. Communication Skill Does not communicate clearly Average ability to communicate Excellent communicator 12. Leadership Ability Follower/low initiative Strong supportive team member Untapped leadership potential Authoritarian leader Strong quiet type leader Natural effective leader 13. Need for Close Supervision Does not respond well to those in authority Needs excessive supervision/guidance Needs accountability and encouragement to set goals and follow through Works effectively with normal supervision 14. Response to Conflict Defensive/critical attitude Withdrawal/avoidance Inappropriate confrontation Uncooperative Positive confrontation Open to resolving conflict Please select the option the most accurately describes the applicant. Adaptability to New Situations/Major Change Below Average Not Observed Average Above Average Superior Self-Esteem/Self-Image Below Average Not Observed Average Above Average Superior Sense of Humor Below Average Not Observed Average Above Average Superior Financial Judgement Below Average Not Observed Average Above Average Superior Moral and Ethical Conduct Below Average Not Observed Average Above Average Superior Energy Level Below Average Not Observed Average Above Average Superior Awareness of Current Events/World Dynamics Below Average Not Observed Average Above Average Superior Ability to Handle Isolation/Loneliness Below Average Not Observed Average Above Average Superior Ability to Handle Stressors Below Average Not Observed Average Above Average Superior Ability to Take Time Off and Relax Below Average Not Observed Average Above Average Superior Relations to Persons of Different Racial and Cultural Backgrounds Below Average Not Observed Average Above Average Superior Awareness of Own Faults and Shortcomings Below Average Not Observed Average Above Average Superior Vocational Focus Below Average Not Observed Average Above Average Superior Check any traits listed below which characterizes the applicant. Illustrate if necssary. impulsive friendly secure positive critical of others jovial mature easily irritated despondent negative intolerant prejudges others flexible argumenative extroverted needs structure indecisive self-starter provincial earns respect of others shy sensitive and caring prejudiced overly dependent puts others at ease Additional Comments: Does the applicant have any undesirable habits or traits? if yes, please explain Do you have any reservations about the applicant's qualifications? if yes, please explain Would you want to work with the applicant in an overseas setting? if no, please explain Rate the applicant's potential for effective overseas service: Should be discouraged Below Average Average Above Average Superior Additional Comments: If you have any concerns or apprehensions which you would prefer to share by telephone, please provide a number where you can be reached during the day or send an e-mail to email@example.com. 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