Your Name *Applicant's Name *Applicant's Employment Dates at Your Place of Work *(Month/Year to Month/Year)What were their primary responsibilities? *How would you evaluate their overall work performance? What are their greatest strengths? *What are some of their weak points/areas in need of improvement? How do they react to criticism? *How did they interact with coworkers? *What was this applicant's reason for leaving? *Would this applicant be eligible for rehire at your place of work? *How does this applicant relate with children/youth? *Does this applicant have the ability and characteristics to be a good influence on children/youth? *The Department of Health and Human Services is requiring all child welfare organizations that currently hold a contract for services to ask these additional questions about any prospective employee who will perform contracted services and have direct contact with individuals in CEDARS care. Has this applicant had substantiated allegations of sexual abuse or sexual harassment, made against them in a prison, jail, lock-up, community confinement facility, juvenile facility, or other institution, including employment with your organization? YesNoNot that I am aware ofPlease ExplainHas this applicant been convicted OR civilly or administratively adjudicated, for engaging or attempting to engage in sexual activity in the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?YesNoNot that I am aware ofPlease ExplainHas this applicant ever resigned during a pending investigation of an allegation of sexual abuse or sexual harassment? YesNoNot that I am aware ofPlease ExplainSubmit