Employment Reference

You have received this invitation to fill out Kids’ Corps, Inc. Reference Form because someone applying for employment has listed you as a person of reference. References may NOT BE RELATED to the applicant and must fill out the official online KCI reference form to completion. The person applying for employment may not fill out their own reference forms. If you have any issues filling out this form or have any questions please contact our HR Department at: (907) 279-2021. A paper reference form may be provided upon request.

Applicant Name (Person applying for employment)*
Position Applied For*
Type of reference*
- Employment
- Professional
- Personal
- School
Length of time employed*
MM slash DD slash YYYY

Start
End*
MM slash DD slash YYYY

End
Eligible for rehire*
- Yes
- No
Length of time you have known the applicant*
Provide information about the applicant in the following areas by selecting the option you feel best answers the area. These questions are required by the Municipality of Anchorage Child and Adult Care Licensing Code for qualifications of caregivers. Please answer these questions to the best of your ability.
Does the applicant show any serious health, alcohol, or drug problems? If yes, explain in comments*
- Yes
- No
Comments
Can you attest to the applicant’s ability to work successfully with children? If no, explain in comments*
- Yes
- No
Comments
If you have never observed this person with children, do you believe this person has the ability to work successfully with children? If no, explain in comments*
- Yes
- No
Comments
Does the applicant show warmth, love, and acceptance of children?*
- Yes
- No
Comments
Does the applicant give firm but fair discipline to children?*
- Yes
- No
Comments
To your knowledge, has this person ever abused or neglected a child, committed a crime of violence, sexual assault, perjury or disorderly conduct?*
- Yes
- No
Comments
What qualities or skills do you believe will enable the applicant to work successfully or unsuccessfully with children:*
If you had a child that was in need of childcare, how would you feel about leaving the child in care with the person named above?*
- Very good
- Good
- Hesitant
- I would not leave my child in their care
Provide information about the applicant in the following areas.
Attendance/Dependability*
Communication (verbal and written)*
Interactions with adults*
Organizational skills and abilities*
Any additional comments
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Phone*
May we share this reference with the applicant?*
- Yes
- No
By typing my name in the field below, I certify that the information provided contains no willful misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge.
Signature*

Please type your first and last name.
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