Reference Check Reference Check

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then submit as a new email with attachment.***then submit as a new email with attachment.***

Dear

Dear

has applied for a position with Behavior Services & Therapy, Inc.

Please answer the following questions to the best of your ability: has applied for a position with Behavior Services & Therapy, Inc.

1. Dates candidate worked for your company or how long you’ve known the candidate:

2. How would you rate the candidate’s dependability:

Poor Fair

Outstanding

1 2 3 4 5

Poor FairOff AverageOff ExcellentOff OutstandingOff Off

3. How would you rate the candidate’s professionalism:

Poor

Excellent

1 2 3 4 5 Outstanding

PoorOff FairOff AverageOff ExcellentOff OutstandingOff

4. How would you rate the candidate’s initiative: 1 2 3 4 5

Average

1 2 3 4 5 Excellent

PoorOff FairOff AverageOff ExcellentOff OutstandingOff Outstanding

5. How would you rate the candidate’s willingness to accept change:

Fair

1 2 3 4 5 Average

PoorOff FairOff AverageOff ExcellentOff Outstanding ExcellentOff

Outstanding

6. What strengths do you feel the candidate possesses?

____________________________________________________________________________________

912 E. LaSalle Ave., South Bend, IN 46617

912 E. LaSalle Ave., South Bend, IN 46617 Telephone: (574) 231-8000 Fax: (574) 231-8013 Email:

Telephone: (574) 231-8000 Fax: (574) 231-8013 Email: kelly@michianabst.com

7. What are areas that the candidate might struggle with?

8. We provide behavior management for individuals with intellectual disabilities and various mental illnesses. How do you feel the candidate will handle interactions with that population?

Please provide any other general comments you would like. Thank you for taking the time to complete this document. Please fill out and email back to kelly @michianabst.com. If you have any questions, please feel free to contact me at (574) 855-6600.

Sincerely,

Kelly L. Howard, M.S., MBA, RBC

Thank you for taking the time to complete this document. Please fill out and email back to kelly @michianabst.com. If you have any questions, please feel free to contact me at (574) 855-6600. CEO/Owner

Sincerely,

Name of person completing this form:

__________________________________

Kelly L. Howard, M.S., MBA, RBC Name of Company:

CEO/Owner _________________________________________________

Contact Number:

Name of person completing this form: ___________________________________________________

____________________________________________________________________________________

Name of Company:

912 E. LaSalle Ave. South Bend, IN 46617

Contact Number: Telephone: (574) 231-8000 Fax: (574) 231-8013 Email:

kelly@michianabst.com

7.

What are areas that the candidate might struggle with?

8.

We provide behavior management for individuals with intellectual disabilities and various mental illnesses. How do you feel the candidate will handle interactions with that population?

____________________________________________________________________________________

912 E. LaSalle Ave. South Bend, IN 46617

Telephone: (574) 231-8000 Fax: (574) 231-8013 Email: kelly@michianabst.com