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SSA and SSB Reference

The document is a reference verification form for a Special Education Assistant position, requiring details about the applicant's supervision, employment history, and performance evaluations. It includes sections for assessing the applicant's interactions with children, coworkers, and their overall work ethic. The form also seeks feedback on any concerns regarding attendance, punctuality, and the applicant's suitability for working with children.

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loraclarke63
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21 views2 pages

SSA and SSB Reference

The document is a reference verification form for a Special Education Assistant position, requiring details about the applicant's supervision, employment history, and performance evaluations. It includes sections for assessing the applicant's interactions with children, coworkers, and their overall work ethic. The form also seeks feedback on any concerns regarding attendance, punctuality, and the applicant's suitability for working with children.

Uploaded by

loraclarke63
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Reference Verification

Special Education Assistant (SSA, SSB)

To comply with the Freedom of Information and Protection of Privacy Act, we are obligated to keep this information
confidential unless you specify otherwise. Would you like this reference to be held in confidence?
Yes or No
Applicant’s Name: Date:
Applicant’s position at the time:
Your Name: Company Name:
Your position at the time:
Did you directly supervise this applicant?
Yes, from: ____________________ (month/year) to: __________________ (month/year)
No, my working relationship is/was_________________________________________________
(ie. Manager, Director, colleague, colleague in a senior position etc)

How long have you supervised the applicant (months/years)?


Dates of employment or practicum:
Was proper notice was given? Yes No
Reason for leaving:

Have you completed a Job Evaluation or Practicum Report for this


applicant? ☐ No ☐ Yes
If so, has it been less than satisfactory?
☐ No
☐ Yes. Please elaborate:

Please check the appropriate box and comment on the following areas
Interactions and Outstanding Proficient Good Average Developing Not
relationships when Demonstrated
working with children.
Comment:
(If you have not
observed them
working with children,
describe their
relationship with
adult clients)
Outstanding Proficient Good Average Developing Not
Demonstrated
Your working
relationship
Comment:

Outstanding Proficient Good Average Developing Not


Relationship with Demonstrated
coworkers/peers
Comment:

Describe a time when


you observed them
working with a
student (or client)
with challenging
behaviours.

December 2022
Reference Verification
Special Education Assistant (SSA, SSB)

Areas of Strength

Areas for
Improvement

Any concerns with their attendance? No Yes

If YES, please explain: _________________________________________________________

Any concerns with their punctuality? No Yes

If YES, please explain: _________________________________________________________

Not including vacation, approximately how many days were they away?
a. Last year _____ b. Previous year (if applicable) _____
a) Work ethic:
Outstanding Proficient Good Average Developing Not Demonstrated

b) Displays a positive attitude:


Outstanding Proficient Good Average Developing Not Demonstrated

c) Deals with stress:


Outstanding Proficient Good Average Developing Not Demonstrated

d) Overall effectiveness:
Outstanding Proficient Good Average Developing Not Demonstrated

Additional comments regarding work ethic, attitude, stress and/or effectiveness:

Do you have any concerns regarding this person working with children? Yes No
If yes, please explain:

Would you hire/re-hire this applicant? Yes No

Reference by:
Thank you!

December 2022

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