Northland Reference Form

Reference Form
Reference's Name*

First NameLast Name
Reference's Email*
example@example.com
Reference's Number*
Please enter a valid phone number.
Applicant's Name*

First NameLast Name
Relationship to the Applicant*

Parent/GuardianTeacherPastorFriendOther
How long have you known the Applicant?*

less than 1 year1-2 years3-5 years5+ years

Applicant Position

Operational staff member is involved with campers daily but spends most of his/her day serving behind the scenes. A counselor spends virtually every moment of his/her day with campers and is directly involved with them on a spiritual level.
I recommend applicant as a(n)....*

Operational StaffCounselor
How much would you recommend this applicant?*

StronglyWith ReservationsNot to be hired
Why? *to previous question*
Are you aware of anything in the applicant's background personality, or behavior that could in any way pose a threat to children or youth?*

YesNo
If yes to the above question, please explain.
By signing, you are stating that the above information is true and filled to the best of your ability.*

Powered by Jotform SignClear
Today's Date*

MonthDayYear
Date
Should be Empty:

Reference Form