Professional Reference

NAME OF APPLICANT*

You are filling out a Professional Reference for the person named above that is applying for a position with Coastal Choices Women's Clinic. Coastal Choices is a non-profit, Christian ministry that offers abortion alternatives & the Gospel to people in unplanned pregnancies.

Keep in mind that this information will be used in making a decision about this person's acceptance as a Coastal Choices staff member or volunteer. It would be most helpful to us if you would be quite candid in your evaluation. Anything that is unknown should be indicated by a question mark. The information you provide will not be shared with the applicant unless you desire to share it with him/her. Please feel free to email our executive director at executivedirector@coastalchoices.org with any addition information or documents.

Thank you!

How long did you work with this person?*

In what capacities?*

How well do you know this person?*

Would you say that this person can exhibit professionalism even in hectic, stressful situations?*

How would you describe his/her attitude, reliability, and effectiveness is carrying out his/her responsibilities?*

How would you characterize his/her work ethic?*

Would you say that this person's professional and personal life is well-ordered/disciplined?*

Please describe him/her on the following using this scale:

X - Unknown
0 - Below Average
1 - Average
2 - Above Average
3 - Excellent

Organization*

Dependibility*

Confidentiality*

Cooperation*

Compassion*

Conscientious*

Submissive*

Self-Motivated*

Trustworthy*

Loyal*

Teamwork*

Computer Abilities*

Learning new computer skills*

Applies Information Learned*

Interpersonal Relationship Skills?*

Does this person tend to become over-committed, starting projects with enthusiasm, but quickly "fizzling out"? *

Give comments about how he/she relates to others:*

What do you consider his/her strong points?*

What do you consider his/her weak points?*

Do you have other observations or comments which might help us in placing this person?*

Would you recommend him/her for service within a Christian organization*

Why or why not?*

Your Name*

Signature*

Clear

Phone*

Email address*

example@example.com

Your Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please call 386-943-4004 with any questions. Thank you!