Name of Applicant
Reference Name (Your Name)
Reference Phone Number
Please enter a valid phone number.
Thank you for answering the following questions as they relate to your knowledge of the above-named applicant.
How long have you known this person?
In what capacity?
Do you know this person on a:
One on one basis
Small group basis (1-29)
Medium group basis (30-99)
Large group basis (100+)
If you employed this applicant, would you rehire them?
In your relationship with the applicant have they been involved in any programs involving adults or children? If yes, please describe their involvement.
Please mark the appropriate circle based on your experience with the applicant.
Capacity to Work with Children
Sense of Humor
Gets Along with Others
If possible, please comment on the applicant's spiritual life.
Assess the applicant's ability to work in a group setting - is he/she a team player? Can he/she follow the rules?
What words or phrases immediately come to mind when describing the applicant?
Would you completely trust this individual to guide and care for your child in a one-on-one setting?
To your knowledge, has there been any reports involving misconduct with vulnerable adults or children against the applicant?
If yes, please describe the report.
Recommend with some reservations
What specific reason would you give for hiring or not hiring this applicant?
Signature of Reference
Should be Empty: