J.U.M.P. Reference Check Form
Instructions: First name, last name, and phone number only for EACH of the three references. Please inform your references that a Human Resources officer from J.U.M.P. will be calling to ask them questions related to your character and suitability for working with children.
Reference Check For (Volunteer Name):
*
First Name
Last Name
Volunteer Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Volunteer Email
example@example.com
Date
*
/
Month
/
Day
Year
Date
Reference #1
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How long have you known this person?
How did you come to know this person?
Do you socialize with this person?
Yes
No
Do you feel this person is a good role model for children and youth?
Yes
No
This person will be working with adolescents and children, possibly as the only adult. Do you have any concerns about the safety or well-being of children in this situation?
Yes
No
Is there anything else you can or feel you should tell me about this person?
Reference #2
Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How long have you known this person?
How did you come to know this person?
Do you socialize with this person?
Yes
No
Do you feel this person is a good role model for children and youth?
Yes
No
This person will be working with adolescents and children, possibly as the only adult. Do you have any concerns about the safety or well-being of children in this situation?
Yes
No
Is there anything else you can or feel you should tell me about this person?
Reference #3
Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How long have you known this person?
How did you come to know this person?
Do you socialize with this person?
Yes
No
Do you feel this person is a good role model for children and youth?
Yes
No
This person will be working with adolescents and children, possibly as the only adult. Do you have any concerns about the safety or well-being of children in this situation?
Yes
No
Is there anything else you can or feel you should tell me about this person?
Notes:
References Checked By:
First Name
Last Name
Signature:
Date Reference Checks Completed:
Submit
Should be Empty: