Form Dhr Cdc 1948 PDF Details

The Dhr Cdc form, officially known as the DHR-CDC-1948 Reference Form, plays a crucial role in the vetting process of individuals applying to work in child care facilities, whether in homes or centers. Created to ensure the utmost safety and well-being of children, this form enables employers to gather comprehensive information about prospective employees' characters, their capability to work with children, and their overall job performance history. Reference contacts, which can include friends, employers, pastors, neighbors, etc., are asked to fill out this form, providing insights into the applicant's dependability, honesty, temperance, and various other attributes that are key to their suitability for child care positions. In addition, the form queries about any potential drug usage, excessive drinking habits, or use of abusive language by the applicant, alongside requesting details regarding past employment and the quality of work performed. Moreover, it seeks to understand if the individual possesses specific qualities, traits, or abilities making him/her particularly fit for taking care of children, and importantly, if there is any reason they might not be suitable for such responsibilities. Confidentiality is assured for the responses, emphasizing the seriousness with which this information is treated to protect children's safety. This process not only highlights the importance of thorough background checks in child care employment but also acts as a deterrent for those who might not meet the high standards required for these roles.

QuestionAnswer
Form NameForm Dhr Cdc 1948
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameswhat help can i get to collect child support in alabama, dhr alabama child support forms, alabama dhr child support excel sheet, alabama dhr forms addendum dependency

Form Preview Example

F.ReferenceForm

DHR-CDC-1948

REFERENCEFORM

Date___________________

To: ________________________

(ReferenceContact)

Address: ___________________________________________________________________________

(Street) (City) (State) (ZipCode)

__________________________________ hasapplied to workina child carefacility(home or center)

(Nameofapplicant)

asa _________________________________________. He/she hasgiven yourname asa persontobe

(Position)

contacted for informationregardinghis/her character,suitabilityto work withchildren andpreviousor prospectivejobperformance. Pleaseanswer thefollowing questionsandprovide anyadditional commentsthat could be helpful.Yourresponse will be kept confidential.

1.How longhave youknown thisperson? ________________________________________________

2.What is/wasyourrelationship withthisperson?(friend,employer, pastor, neighbor, etc.)

__________________________________________________________________________________

3.

Inyouropinion,isthisperson:

 

 

 

Comments: _______________________________________

 

Dependable?

Yes

 

No

 

 

 

 

 

 

 

 

Honest?

Yes

 

No

 

 

 

 

 

 

 

 

Eventempered?

Yes

 

No

 

 

 

 

 

 

 

4.

Toyourknowledge, doesthisperson:

 

 

Comments: __________________________________

 

Usedrugs?

 

Yes

 

 

No

 

 

 

 

 

Drinkexcessively?

 

Yes

 

 

No

 

 

 

 

 

Useabusivelanguage?

Yes

 

 

No

 

 

 

 

5.If youare/werean employer of thisperson, describe the typeof work theperson does/did and the quality ofthe workhe/she performed. What wasthe reason forthe person leavingyour employment,if applicable?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

6.If youhave young children,would youleave your own child/children inthe care of thisperson?

Yes

No

If no, please explain.

__________________________________________________________________________________

__________________________________________________________________________________

88

EffectiveJanuary22, 2001

7.Toyourknowledge, doesthisperson have qualities, traits,or abilitiesthat make him/her particularly suitableto carefor children?

Yes

No

Pleaseexplain.

__________________________________________________________________________________

__________________________________________________________________________________

8. Do youknow of anyreason why thispersonmight not besuitable to careforchildren?

Yes

No

If yes,pleaseexplain.

__________________________________________________________________________________

__________________________________________________________________________________

9.If youhave any additionalcommentsabout thisperson you feel wouldbe useful whenconsidering his/her application for employmentin achild carefacility, pleasestatebelow.

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

 

 

_________________________________________________________

 

 

 

Signature

 

Date

Telephone number

Pleasereturnthisformto:

 

 

 

 

 

 

 

Name of personrequesting information:

 

CharlotteRay

 

 

Nameof childcarefacility(home/center):

Trinity Child Development Center

Addressof facility:

 

 

 

 

 

 

 

Street:

 

1400 OxmoorRoad

 

 

City:

 

Homewood

 

 

 

 

State:

 

Alabama

 

ZipCode:

35209

 

Telephone Number:

(205) 879-1749

 

 

 

 

If youprefernottoprovide areferenceforthisperson, please sign hereand return thisformtothe addressabove.

_________________________________________________________

SignatureDate

89

EffectiveJanuary22, 2001

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