Reference Questionnaire

Please fill out the below form. All responses will be confidential and sent directly to Tibetan Care. Thank you very much for providing feedback!

Former Employee's Name

Reference Name (Your Name)

Reference Email (Your Email)

Reference Phone (Your Phone)

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When did caregiver work for you?

Please provide dates if remembered.

Who did s/he care for? At what ages?

Why did s/he leave?

What were her/his duties?

What was her/his compensation level?

Overall Evaluation

Agree/disagree with the following: Caregiver was proactive, communicates well in English, well organized, handles stress, warm & social, works well independently

How would your children describe caregiver?

Any final comments or advice to new employer.

Is there any reason why a family should NOT hire this person?

Please describe here if s/he behaved in an unsafe or harmful manner.

Would you hire her/him again?