Applicant Reference Form

Thank you for serving as a reference for one of our applicants! Below are several questions regarding the candidate. Please complete the questionnaire to the best of your ability, and please provide as much detail as you are comfortable doing. We may follow up by phone or email if there are any additional questions. We appreciate your taking the time to fill out our survey!

If you would prefer to provide a reference by phone, please call our office at 617-505-6183.

 
 
Your Name *
Your Name
Please provide a phone number we can call only if we need clarification or follow up information.
1. In what capacity do you know the candidate? *
While multiple options may apply, please pick the most relevant relationship.
Please also include some information about the population the applicant worked with in this setting.
3. On a scale from 1 to 5 how would you rate the candidate's promptness and reliability? *
This may including addressing the applicant's arriving to work on time, and/or replying to emails or phone calls in a timely manner.
4. On a scale from 1 to 5 how would you rate the candidate’s professionalism and communication skills? *
5. If you had the opportunity would you hire the candidate? *
6. On a scale from 1 to 5 how well does the candidate demonstrate task management skills or consistency when it comes to remaining on-task?
7. On a scale from 1 to 5 how would you rate the candidate’s organizational skills?
8. On a scale from 1 to 5 how would you rate the candidate’s flexibility and adaptability to change, including scheduling and responding to constructive criticism?
9. On a scale from 1 to 5 how would you rate the candidate's professionalism in exercising good judgement?
10. Do you think the applicant will be a successful behavior therapist? *
Please feel free to include any other details or comments that are not covered in the area above.