Department of Residence Life
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Applicant Name:
Optional Waiver: This reference shall remain confidential and I hereby waive any and all rights I may have to access or review this document as granted under the provisions of the Family Educational Rights and Privacy Act of 1974 and/or as granted by any other federal, state, or local law.
Applicant signature (optional): Date:
The person above is seeking a position in the residence halls at Pacific University. We would appreciate your candid evaluation of them. If the applicant agreed to the waiver above, your reference will remain confidential. If the applicant did not agree to the waiver, they may have a right to view this reference at a later date.
Based on your general impressions of college students, please rate the applicant using the following scale:
Needs Improvement: performance fails to meet expectations; skill level is behind or below others
Below Average: sometimes needs extra attention, guidance, or motivation just to meet minimum expectations
Average: skills are typical for people of their age and experience, a perfectly acceptable rating
Above Average: performs better than most, demonstrates maturity or advanced skill level
Exceptional: performance almost always exceeds expectations; skill level is rare for people of their age
Judgment
Exceptional
Above
Average
Average
Below
Average
Needs
Improvement
No basis for judgment
Specific Qualities
(Underline or circle words you believe to be applicable) mature, adequate, inconsistent, good decision making skills
Responsibility
Leadership
Cooperation
Initiative &
Resourcefulness
Understanding
Interpersonal
Skills
Adaptability
Emotional
Stability
Time
Management
Ethics dependable, consistent, erratic natural, latent, follower, mature, immature, good attitude, poor attitude, encouraging, dominating contentious, supportive, selfish, obstructive, team-player confident, imaginative, original, persevering, easily discouraged, lazy, assertive, burned out quick, teachable, average, slow to grasp material extroverted, approachable, tactful, accepts criticism, introverted, closed, blunt, easily offended, critical flexible, open-minded, prejudiced, rigid, tactful, outspoken, blunt, positive stable, self-controlled, often stressed, easily disturbed, unpredictable balances academic & social life, overcommitted, imbalanced, organized good role model, hypocritical, follows policy, does not follow policy, has integrity, judgmental

I am the applicant’s RA I work(ed) with the applicant Other:_____________________
Please describe how you have interacted the applicant (e.g. through work, programming, religious activity, etc.):
In your opinion, what are this applicant’s most outstanding qualities/strengths?
Do you have any concerns about the ability of the applicant to fulfill the responsibilities?
Is there anything else you think we should know when considering the applicant for employment?
Referrer Signature: Date:
Due Friday, February 19, 2016 at 5 pm to the Student Life Office.
If you have any questions please do not hesitate to contact the Search Committee at reslife@pacificu.edu
.