Reference Form

The form will not be shared with the nanny candidate.

General Information

* Your First and Last Name:  
* Your Email:  
Your Phone:  
Nanny's Name:  
Type of Reference:  

Childcare Reference

Ages of Children and Duties Performed:  

Personal Reference

Years Known:  

Professional Reference


For All References

Areas to improve on:  
Why would you think this person is suited to work with children?:  

Rank this Person

Please rank the person 1-5, with 5 being the best on the following attributes.
Enthusiastic about job:  
Was job commitment fulfilled:  
Demonstrated good judgment/common sense/thinking on their feet:  
Interacted well with children/Co-workers:  
Communication skills:  

Additional Information

Overall quality of work:  
Reason for leaving (if applicable):  
Would you employ this person again? (if applicable):  
  Yes No 
Please explain:  
Any other comments?:  
Form Validation:  
Write the letters from the image in the space provided: