Telephone Reference Check

Name of applicant

Date

Reference provided by

Address

City

State

Zip

Phone day

evening

1. How long have you known the applicant?_

2. In what capacity do you know the applicant (friend, neighbor, employer, etc.)?

3. Is the applicant currently taking care of your child?_

4. If yes, how long has the applicant been doing so?_

5. Has the applicant taken care of your child in the past?_

6. If yes, what were the approximate starting and ending dates?_

7. If the applicant has cared for your child, was/is this work steady or occasional?

8. On average, how many hours per week did the applicant work for you? If steady, what was the applicant's schedule? _

9. How old were your children at the time the applicant cared for them? Are they girls or boys?_

10. What were the applicant's responsibilities while in your employ?_

11. Why did (or will) the applicant stop working for you?

12. Do you know of any physical or psychological limitation that would interfere with the applicant's ability to do a good job, including an eating disorder or family conflict? _

13. Are you aware of any drug or alcohol abuse on the part of the applicant?_

Was the applicant usually on time? Was she sick often?

15. Describe the applicant's maturity, reliability, and ability to handle emergencies.

16. Describe how the applicant relates to children. (Is she playful, warm, etc.?)

17. How does the applicant discipline children?

18. What are the applicant's strengths?

19. What are the applicant's weaknesses?

20. Is the applicant willing to listen to your ideas about child care?

21. If you needed a caregiver now, would you hire the applicant? _

23. Overall, would you recommend the applicant as a child care provider?

25. Other comments:

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