Personal Reference Request Breakaway 2023

REFERENCE REQUEST FOR*

At which ISM Event is he/she applying to serve?*

Breakaway KidsBreakaway TeenBoth Breakaway Kids and TeenUnknown

Your First & Last Name*

Your Address*

How long have you known this applicant?*

Can you vouch for the moral integrity of this applicant?*

YesNo

Is this applicant free from the use of tobacco, alchohol or other drugs?*

Has this applicant, during the last ten years, been convicted of a crime, excluding misdemeanors and speeding tickets?*

YesNo

If yes, please explain:*

In the past 5 years, has the applicant had any negative changes intheir moral, marital, or other life situations?*

YesNo

If yes, please explain:

Does this applicant have adequate spiritual and emotional maturity necessary for praying with campers regarding the various problems with which they may be presented?*

YesNo

Is there any information about this applicant you feel would be necessary for us to know?

Would you recommend this person to be a counselor at Breakaway?*

YesNo

E-mail*

Confirmation Email

Phone Number*

Signature*

Clear

YOU MUST CLICK "SEND FORM" BELOW OR YOUR FORM WILL NOT BE SUBMITTED!

You will receive a confirmation email as well. If you are not directed to a Thank You Page and do not receive a confirmation email, your submission was not sucessful. Feel free to contact ilsmonline@idcag.org if you have any questions as to whether your submission was successful.

Thank you!

Please Comment On The Following