YWECC Confidential Reference Form

Thank you so much for being willing to be a part of the application process for our summer internship program. It will become a part of the applicant's application and will be used to help determine his or her suitability for our summer staff. No single reference will determine acceptance or refusal, so frank appraisal will be appreciated by both the candidate and the youth staff. All information is confidential. Please be sure to fill out the applicant's name when filling out this reference form so that we know WHO you are referring to. If you have any questions please email leah.gaffney@westendcc.org.
Please note: The person for whom you are filling out this form will not be considered for hire until you have submitted this confidential form.
Thank You,

Leah Gaffney
Contact Info

In case we need more details regarding this reference.
Your Full Name*

First NameLast Name
Your Phone Number*
Format: (000) 000-0000.
Your Email*
example@example.com
I'm completing this form as a:
Applicant Full Name (NOT your name)*
The name of the person for whom you are filling out this reference form
Questionnaire

Please respond to the following questions clearly and concisely.
How long have you known the applicant and in what capacity?*
Please give your frank evaluation of the applicant's:
A. Christian faith and maturity: *
B. Potential or actual skills or abilities related to church youth work: *
C. Outstanding strengths: *
D. Weaknesses:*
Please give your frank evaluation of the applicant's:
Work Ethic

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5

1 is Poor, 5 is Excellent
Initiative

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5

1 is Poor, 5 is Excellent
Responsiveness (to needs/concerns of others)

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5

1 is Poort, 5 is Excellent
Teamwork

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1 is Poor, 5 is Excellent
Leadership Abilities

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1 is Poor, 5 is Excellent
Interpersonal Skills

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1 is Poor, 5 is Excellent
Sense of Humor

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4

5

1 is Poor, 5 is Excellent
Is there anything you would like to elaborate on concerning the above?
YesNoUnsureOther
YesNoOther
Very WellWellWell, depending on the situationPoorlyI have no knowledge regarding this questionOther
Yes, without reservationYes, with some reservationsNoUnsureOther
Please place a check in the box that best describes the applicant. Please CHECK ALL that apply. Please skip any questions in which you have no knowledge.
Very PopularMakes Friends EasilySlow to Make FriendsGenerally a LonerOther
Healthy and supportiveHealthy, but not currently supportiveProblematic, but supportiveProblematic and not supportiveOther
Copes WellAdapts SlowlyWithdrawalsDominates the situationBecomes overly critical of othersOther
Relates WellMature / AppropriateInappropriateInsensitiveInsecureDiscriminatory / SexistUnhealthyOther
Mature and ConsistentMaturing / Fairly ConsistentGrowing / Showing signs of continued maturityUp and Down / Inconsistent spiritual experienceImmatureOther
Independent worker / able to take direction and goWorks well once given directionNeeds regular supervisionNeeds accountabilityDoes not respond well to supervisionLazyOther
Works well with othersAverage ability to work with othersOccasional difficulty working with othersDoes not work well with othersOther
PeacemakingOpenness to resolving conflictConfrontationWithdrawal / AvoidanceLack of cooperationDefensive / Critical AttitudeOther
Is there anything else you think we should know about the applicant or their suitability to be a part of the summer staff at West End Community Church? This is your chance to sing their praise or confidentially warn us about a potentially bad hire.
Thank you so much for taking the time to fill out this reference form. We appreciate it, as does the applicant. You have obviously made an impact on this applicant’s life, so I want to encourage you in that. If you have any questions or would like to talk with me about anything regarding this applicant, please feel free to call me at 864-373-1369. Thank you again for your time!

In Christ,
Leah Gaffney
Youth Director

West End Community Church | Nashville, TN
A Must HireHighly RecommendedRecommendedRecommended with some reservationsNot recommended by me for your ministry this summer
Signature*

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Contact Info

Questionnaire